How to Determine the True Cost of Your Policy

The true cost is the total/annual amount you will pay in premium costs, plus the cost of your deductible plus the cost of any co-payments (including prescription benefits). Do not be fooled into thinking that your policy is only the cost of the premium.

You should factor in at least three physician visits and at least one Emergency Room visit per year. You will want to include the co-payment for any prescriptions (if you are not currently on any medication, factor in a week's worth of antibiotics at least once in the year).

There is a certain additional "cost" that is more difficult to put a price on. You have to consider the cost of benefits or services with restricted access.

Here is an example:

You are paying for a policy which includes 25 chiropractor visits per year or more if "medically necessary". Last year, you did not "need" the services of a chiropractor. Unfortunately, this year, you strained your back and are singing the praises of your chiropractor and your insurance policy.

Because you were able to go to a chiropractor immediately after you strained your back, after only three visits, you are feeling as good as new and you didn’t have to miss a day at work!

Here is the same example with a bit of a spin:

Last year you did not need the services of a chiropractor. This year, you strained your back. You went initially to your primary care physician (PCP) who prescribed a medication to help relax the strained muscles and ordered you to remain off of work until you can be re-evaluated in two weeks.

Two weeks later you are still in pain. Your PCP orders physical therapy to instruct you in a home exercise program. You are to remain off of work until you can be re-evaluated.

Some time has passed since your original complaint of back pain. The medication didn't work. The home exercise program didn't work. You really really really want to see a chiropractor which is part of your insurance coverage.

Beginning to see the true cost?

You again go to your PCP. Finally, after threatening to file a complaint, your PCP submits a request for the "group's consideration" of an evaluation visit by a chiropractor. Several weeks pass and the group finally completes its review of your request and authorizes one evaluation visit by a chiropractor.

You can see how frustrating it can be to have a benefit but not have easy access to it?! Access to care is the intangible that is part of the true cost of a health insurance policy.



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