I Made A Mistake

July 6, 2006 by bob.

Q. Two years ago you recommended a health insurance plan for my family. At the time I felt like there were better plans available than what you were suggesting. I bought from another agent, and another carrier and have been dissatisfied ever since. When I try to use the plan many doctors will not file the claim but require me to pay up front and then collect from the carrier. When the carrier does pay, it is never as much as the doctor charges. What can I do to get away from this plan.

A. Your situation is not unique. I have several clients now who felt they could get a better “deal” elsewhere. Some used another agent; others bought direct from the carrier.

The plan you have is a reasonable & customary plan that is not tied to any network providers. The doctors you use are free to charge market rates and you must make up the difference in what the carrier is willing to pay and what the doctor charges. This always leaves you in the hole.

Plus under that kind of plan you never know what your out of pocket cap will be on a major claim.

The plans I recommend always have clearly defined caps and are always tied to a network where the providers are bound by contract to accept what the carrier offers as payment in full.

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