A lot of people that have to buy their own buy health insurance, particularly short term health insurance do not know what to expect if they actually have to use it.
They often expect one thing to happen, and are shocked when something else altogether happens.
Here is a short explanation of what to expect when you need to use your short-term health insurance.
The Big Stuff Major, or catastrophic expenses that come with hospital stays are covered by most short-term health insurance policies if they are medically necessary and not experimental.
So, what should you expect if something big happens and you find yourself in the hospital racking up tens of thousands of dollars worth of hospital charges? In most cases, the most you will have to pay will be your deductible and coinsurance.
I have written other articles on this site that talk about deductibles and coinsurance, so I will not go into that here.
Here is how to use your insurance at the hospital and what to expect.
Present your short-term health insurance card at the time of service (Some hospitals refuse or limit service based on whether or not you have health insurance).
The hospital will bill your short-term health insurance company for any expenses.
You should not have to pay any money at the time of service.
A few weeks later you will receive a letter from the insurance company called an Explanation of Benefits (EOB).
The EOB will tell you what was billed, how much they charged, any discounts applied, how much the insurance company will pay and how much you are responsible to pay.
The EOB can be a little confusing at first.
If you need help understanding it, your insurance agent should be able to help.
Once you have received the EOB you should contact the hospital, doctor, or other provider to make payment arrangements.
A Couple Quick Notes First, if you do not have all the money to pay your portion of the bill, many hospitals will (sometimes grudgingly) allow you to make monthly payments to make it possible for you to pay off your bill.
There is usually no interest charged for these arrangements.
Second, if you owe the hospital over a thousand dollars, and have the cash to pay it off immediately, you may be able to negotiate for a lower payoff.
There are services available that will negotiate with the hospital for you.
They do not charge unless they are able to save you money.
And, then they only charge a quarter or third of the amount they are able to save you.
Doctor Office Visits Visits to the doctor are covered by most short-term health insurance policies.
But, there is no copay.
You are responsible for any expenses at the doctor's office until you have met your deductible.
After that, you split expenses according to your coinsurance.
Here is what to expect at the doctor's office when you use your short-term health insurance.
Present your insurance card during your visit and tell them to bill your insurance company.
You should not have to pay any money at the time of the doctor's visit.
They will send the bill to your insurance company.
A few weeks later you'll receive an EOB from the insurance company.
Once you receive your EOB you should contact the doctor's office to make arrangements to pay the amount you owe.
Pay only the amount shown on the EOB.
If the doctor's office says you owe more than the EOB shows, you should contact the agent that sold you the policy for help resolving the issue.
Outpatient lab tests and x-rays are generally covered by most short term health insurance plans.
Labs will generally bill your insurance before sending you a bill.
If you get a bill from the lab be sure to verify any amounts on it with the insurance company's EOB to make sure you are paying only what you owe.
Prescriptions This is definitely one of the things you should make sure of when buying short-term health insurance.
Some companies cover prescriptions and some do not.
If they are not covered by the plan, you may get a discount card.
That may allow you to get your prescriptions at a slightly discounted cost, but no matter how much you spend, the insurance company will not pay any part of the expenses.
Here's what to expect if prescriptions are covered by the policy.
When you go to the pharmacy to buy a prescription you present your insurance card.
The cost of your prescription will be discounted based on the drug and where you live in the country.
Then the price you are charged is applied to your deductible and coinsurance.
If you have not met your deductible, you will be charged the entire, discounted price.
If you have met your deductible, then the discounted price is applied to your coinsurance.
You will be charged your percentage of the price based on your coinsurance rate (usually 20-50% with most plans).
If you have met your deductible and coinsurance, then the insurance company pays the entire cost and you will be charged nothing.
Unlike the hospital, or doctor's office, you will have to pay any amount you owe on the spot in order to take your prescription home.