Have Not Health Insurance

Something has happened that I could never have imagined. Everyone in the U.S. that purchases health insurance have been divided into the “Haves” and “Have Not” categories.

I worked in corporate America for many years and I was always able to access a good doctor, pay my “co-pay”, get whatever care that was needed and move on to the next item on my “to do” list.

Now that I started my own business, I no longer have an “employer sponsored group plan” for my health insurance. I now have insurance that costs $600+ per month that I will apparently have great difficulty getting to use.

If you are fortunate enough to “have” an employer sponsored group plan, you will have better access to using your insurance. If you “have not” this type of plan and have an individual plan either because you own a small business or your employer no longer sponsors a group plan; my sympathies are with you.

I rarely get sick. (Knock on wood.) Last year, I went to my doctor who I have had for 12+ years with my “new” health insurance and was told by the receptionist that they accepted my insurance so I gave them a $25 check for my co-pay. I just needed to renew prescriptions. Upon leaving, I was notified that they did not accept my insurance and I would need to pay an additional $175.00 in addition to the $25 check I had already given them. They gave me the paperwork to get “reimbursed.” I sent it in to the insurer the same day. I was never reimbursed.

This year, I got a different company who had my doctor listed as a preferred provider on the insurer website. I have a PPO plan. I called my doctor to make an appointment and was told that she was no longer accepting insurance and would be moving to a “cash only” service in about a month. The receptionist said she would make an appointment for me if I had an employer sponsored group plan otherwise they were already only offering their service as cash only. I would have to submit paperwork for reimbursement. I asked how much it would cost for this “cash” appointment. She said she had no idea but finally said “perhaps” $80 after I pressed her for an answer. The same appointment cost $200 last year so I’m guessing the prices have not been reduced this year.

This is not an isolated occurrence. I have friends telling me the same story. I get it! The doctors are fed up with dealing with insurance carriers that pay pennies on the dollar for services rendered. They also might have to wait months to even get that money if the paperwork submitted was completed correctly.

The idea that I have health insurance and can see the doctor of my choice and pay a certain co-pay is a joke. The healthcare system is completely broken. I just hope I don’t get sick!

The Three Most Common Types of Insurance

There are many insurance plans available to offer coverage for various sorts of damage or accidents. All families should have at least one of these three.

Types of Homeowners Policies

Homeowner’s insurance falls under one of six categories. HO-1 and HO-2, as they are more commonly known, cover only the property against specifically listed damage. These policies vary as to what damage is covered, and neither protects belongings located on the property. HO-2 forms offer more coverage than an HO-1.

HO-3 protects against all types of damage, not just specifically listed damage. It also protects a select list of belongings located within the structure from specific damage.

HO-4 and HO-6 cover only belongings. Renters use these policies as the landlord or management company holds coverage on the dwelling. As with HO-1 and HO-2, HO-6 offers greater protection than HO-4 and is more expensive.

HO-5 is similar to HO-3 in that it covers the property as well as personal belongings. The difference is that HO-5 covers all belongings, not just a set few. It is also more costly than some of the others, but it is worth it.

Types of Medical Options

Medical is another common form of insurance, and as with homeowners, there are different kinds for you or your employer to choose.

Health Maintenance Organization, or HMO, is one of the most used types. This plan allows you to choose from a network of providers, and it also includes preventative care. However, you must be referred by your primary care physician in order to see a specialist. There is also a small copay you must pay at each appointment.

The Preferred Provider Organization, or PPO, also has a network of doctors available. Unlike an HMO, you do not have to choose a primary care provider. You can see any physician, or even a specialist, as long as he is in network. Also, you do not have to have a referral to change doctors. As with other plans, each visit requires a copay.

Exclusive Provider Organization, or EPO, works very similar to HMOs and PPOs. These cost less and have a network of providers available. However, unlike a PPO, where an out of network doctor visit is covered up to a point, there is no out of network coverage for these plans.

The Point of Service Plan, or POS, is a hybrid between an HMO and PPO. POS requires a primary care provider assignment, but you can see out-of-network doctors if you are willing to pay a higher copay.

Different Auto Coverage

Auto insurance is also widely used. Depending on your loan terms and state requirements, some options may be unavailable to you.

Liability plans cover damage and medical bills in the event the accident was deemed your fault. It only covers the damage done to the other person’s property as well as any of their medical bills. Most states require this as minimal coverage. It is also the most inexpensive option available.

Collision coverage will pay for repairs to your vehicle in the event of an accident. This type of insurance is worth having, in addition to liability coverage, even if you have an older vehicle that has no lien. In the event that your vehicle is totaled, your plan covers the value of your car. This policy is required for those with lienholders.

Comprehensive coverage covers anything unrelated to an accident like if your vehicle is stolen or you hit a deer. For most lienholders, this is a requirement.

Uninsured motorist is something that everyone should consider. While most states require at least liability coverage, some drivers don’t keep the plans much past getting their license or tags. This policy protects you in case someone else causes damage and doesn’t have a plan in place to pay for repairs.