I just recently ran into a few situations, where clients were concerned about “Out of Network benefits”. Typically in the health insurance world there are 2 types of coverages, “In Network Only Plans” (HMO’s, and EPO’s) and “In and Out of Network Plans” (PPO’s, and POS).
Now the question I hear the most often is, “How do out of Network benefits work?”
Typically, aside from the deductible you have to meet, there is a UCR %. What UCR means is “Usual, Customary and Reasonable”, this simply means the insurance company calculates the reasonable “cost” of the procedure and picks up that %.
It does NOT mean they will pick up that % of the total cost.
Let me give you an example.
You have a $25,000 procedure done by your doctor, your UCR % is 80%, and the insurance company thinks the reasonable cost of the procedure is $20,000.
This means they WILL PAY 80% of the reasonable $20,000 which is $16,000.
Leaving YOU with a total cost of $25,000-$16,000= $9,000.
It doesn’t mean your doctor overcharged you for a procedure, it’s simply based on how insurance companies calculate reasonable costs.
The other misconception many client have is “What if I have no out of Network benefits and someone gets hurt out of state? (i.e. on vacation).”
The simple answer… YOU’RE COVERED!
All insurance plans have to cover you regardless of whether your In Network or NOT in EMERGENCY SITUATIONS!
So, you may not be able to get a check up Out of Network but you will be covered for hospitalization!
Make sure to ask questions and see if out of network benefits are worth the additional cost!
If you have any questions you can always reach me at 631-338-9917.
Related Posts: Should I hire someone to manage my benefits?
Related Posts: Should my company have an employee advocacy program?
Related Posts: Benchmarking and why its important for your business
Showing posts with label EPO. Show all posts
Showing posts with label EPO. Show all posts
Tuesday, December 15, 2009
Tuesday, November 17, 2009
Why pay for one plan, when you can have two or three…
The startling thing that I’ve encountered with businesses is they only offer one medical plan.
Why do you think that’s the case? Because they didn’t no better!
I bet if I took out 20 business owners and offered to buy them ice cream the majority of them would say yes… but what if I offered to buy them ice cream with the catch that they can only order coffee ice cream with no toppings? Nothing against coffee ice cream but I’m sure I would get more no’s then when I gave them options… Do you see what I’m getting at? People tend to have different needs, and they tend to value different things. So why only offer one medical plan, when you can have two or three for the same cost?
Most employees will be thrilled that you gave them choices. Maybe they wanted a better drug card, or an improved network. Maybe the most important thing to them is paying the least amount possible. When you have employees from different walks of life they have different needs. Does a 25 year old go to the doctor as often as a 60 year old? NO, at least not usually but let them choose!
THE BEST PART IS… THIS DOESN’T COST YOU MORE MONEY!!! THIS IS A WAY TO OFFER MORE DIVERSE BENEFITS TO YOUR EMPLOYEES WITHOUT ANY ADDITIONAL COST!
IF YOUR BROKER DIDN’T MENTION THIS TO YOU ALREADY, YOU MIGHT WANT TO ASK HIM WHY!
If you have any questions you can always reach me at 631-338-9917.
Why do you think that’s the case? Because they didn’t no better!
I bet if I took out 20 business owners and offered to buy them ice cream the majority of them would say yes… but what if I offered to buy them ice cream with the catch that they can only order coffee ice cream with no toppings? Nothing against coffee ice cream but I’m sure I would get more no’s then when I gave them options… Do you see what I’m getting at? People tend to have different needs, and they tend to value different things. So why only offer one medical plan, when you can have two or three for the same cost?
Most employees will be thrilled that you gave them choices. Maybe they wanted a better drug card, or an improved network. Maybe the most important thing to them is paying the least amount possible. When you have employees from different walks of life they have different needs. Does a 25 year old go to the doctor as often as a 60 year old? NO, at least not usually but let them choose!
THE BEST PART IS… THIS DOESN’T COST YOU MORE MONEY!!! THIS IS A WAY TO OFFER MORE DIVERSE BENEFITS TO YOUR EMPLOYEES WITHOUT ANY ADDITIONAL COST!
IF YOUR BROKER DIDN’T MENTION THIS TO YOU ALREADY, YOU MIGHT WANT TO ASK HIM WHY!
If you have any questions you can always reach me at 631-338-9917.
Subscribe to:
Posts (Atom)
