| Guide
to Choosing an Insurance Company
Great progress has been made in the treatment of bleeding disorders
over the last 30 years. During this time we have gone from treating
with whole blood products such as cryoprecipitate or lyophilized concentrates
to the new generation recombinant products. Unfortunately, this progress
comes at a steep financial price. As a result, management of bleeding
disorders places a large financial burden on affected individuals and
their families. In fact, clotting factor products are among the most
costly treatments in the world, with total annual costs in excess of
$100,000 per year.
There are many things to take into consideration when choosing an insurance
company, if indeed you have a choice. Perhaps more so than anyone in
your office, you need to keep yourself abreast of what your company’s
Insurance Plan and Policy’s are. Larger companies generally have
more options, while smaller companies may only have one policy in place.
Some things to keep track of are:
• Open Enrollment Period
This is a time that your company allows you to change coverage (if you
have more than one option) or add more family members to your plan.
• Insurance Options
POS (Point of Service), PPO (Preferred Provider Organization), HMOs
(Health Maintenance Organization), and private insurances all have their
pros and cons. Investigate what your out of pocket will be (i.e. will
you have a deductible or a co pay), what the lifetime caps are ($500,000
or a $1,000,000) and what the limits of your policy are (does it cover
the cost of a home health nurse, laboratory analysis, HTC visit, or
even the cost of factor). Oftentimes, you will find that you may base
your decision on physician choice and cost savings.
• Know and Monitor Explanation of Benefits (EOB)
This comes from your insurance company and summarizes/explains the amounts
approved and paid to health care providers. It also explains why certain
services were denied and advises you of your financial obligation. We
can’t stress enough that you need to be an informed consumer you
need to be aware of what you’re being charged for your factor
and monitor it regularly – homecare companies and other factor
providers vary greatly in what they charge consumers. There are many
unfortunate individuals who have failed to track what their insurance
companies are paying out and the end result is that they cap out (reach
their limits) on their insurance coverage much sooner than necessary.
• Lifetime Caps (or maximum lifetime benefit Limit)
Many carriers set this limit at 1 million – If you contact the
foundation, we will work on your behalf to negotiate with your insurance
carrier to waive or extend this limit or. If we are unsuccessful we
can help you find alternate insurance coverage.
• Dependent Coverage
Children are usually covered until they reach the age of 19. However,
most policies allow you to extend this period to 23 years-of-age as
long as your child is a full time student (12 credit hours or more at
a higher learning institution). Also, if you work for a larger company,
your children may be eligible for COBRA (a federal program that enables
you to continue their insurance coverage by allowing you to pick up
the cost).
• Secondary Insurance
Some
individuals may qualify for back up coverage, either through state or
private insurance. Some health care providers will bill the secondary
insurer for expenses not covered under the primary insurance plan. Check
your EOB (Explanation of Benefits) to determine whether the other insurer
has been billed. If not, contact the primary insurer and update your
information to include your secondary plan.
If you need help in choosing a policy, assistance in understanding its
terms and conditions, want to know about other options available to
you, or have a problem with a medical bill, please don’t hesitate
to call our office for assistance.
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