What Does My Health Insurance Cover?

By | February 15, 2019
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Health insurance is a topic that is not only very polarizing, but is also scary because of the ever-changing environment and policies that are employed. Most people are not sure what is covered, at what rate, at any given office, until an event happens that needs attention. Barb recently found out that despite all the preparation and research that a person can put into understanding their exact situation, things can still go awry.

Barb and her husband Bill recently planned a vacation to Africa. In order to travel to this foreign land, they attended a travel clinic seminar, that they paid for out of their own pocket because they knew ahead of time that their health insurance did not cover such a visit, in order to acquire the best and most accurate information about the kind of immunizations, medications, and potential health risks that they would need to consider. The physician at the clinic was fantastic and spent quite a bit of time explaining what was at risk in their specific areas of travel, the different types of shots they should have and when they should have them before traveling, and the types of medication they should bring with them for daily use. Barb wrote everything down and called her member services number when she returned home to find out which medications and vaccinations would be covered when she and Bill went to her family physicians office. It turned out, she was told, all the necessary shots would be covered except one, which was not offered at any of her network clinics since it was only needed for travel. Barb and Bill went back to the travel clinic to obtain, and pay for, that particular shot.

The next step was when Barb made a joint appointment for her and Bill to go to their family clinic and obtain the rest of the vaccinations. Since these were all to be covered by their health insurance, the two of them saw no reason to pay for them out of their own pocket at the travel clinic. A couple months after the visit to the family health clinic, they received a statement in the mail staying that Bill owed 136 dollars for his appointment. Barb owed nothing. This made no sense, and so the phone calls began to clarify the bill. Four months later, the bill is still outstanding because Barb has spoken to multiple representatives from the member services department of her health insurance who have repeatedly stated that the services rendered are covered in full and after the bill is re-filed, there will be no charge. However the people at the family clinic have re-filed several times now, and the bill is continually returned that only Bill owes money for the visit.

It is truly confusing to try to figure out how two people at the same appointment, with the same insurance, the same services rendered, and the same preparation could have different amounts due. Health insurance is very tough to figure out!

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