Is Your Health Insurance Good For You?

Published March 28, 2017

Imagine that you don’t feel well. You have had nausea and vague abdominal pain for a week, and you notice that your belt is getting tighter. You have not seen a doctor in a while and sense something could be seriously wrong. So what do you do?

Here are two possibilities:

  1. You pull out the insurance card that you got through the ObamaCare exchange—a card that made you feel secure as you got it at a great discount because of government subsidies. You read the fine print that sends you to the insurance company website. You find the list of “preferred providers” and begin making phone calls. After going through 15 numbers and being told that the doctor is not taking new patients, you finally find an office that gives you an appointment a month away. Frustrated and increasingly alarmed, you go to the emergency room, thinking that your insurance will cover it. They do a host of tests and finally determine that you have some sort of virus and that you have put on weight due to recent overeating. You are reassured and relieved. A few weeks later you get a bill for $8,000. Your ObamaCare insurance negotiated that down from $12,000, and you are grateful for that. But since your deductible is $8,000, you will begin to pay $100 per month for many years to come.
  1. You call the doctor you have seen through the years. He was there when you developed diabetes and was able to get it under control quickly. Same with your blood pressure. He is the one who convinced you to stop smoking. You pick up the phone to make an appointment, and the friendly receptionist, who knows your name, says you can come in the next day. You get to the office where the staff greets you, asks about your family, and does not make you fill out the same long form with all your insurance information—a gain. This doctor does not belong to any network and does not take any insurance. He can focus on what you need, being mindful that you will be paying for tests and medicines out of pocket. Since you have an $8,000 deductible, chances are your insurance won’t help.

Once in the exam room, the doctor takes time to listen to you and examine you, and thoughtfully considers what your signs and symptoms might mean. He does an EKG, draws some blood, and assures you that the lab bill you will get will be less than $100. He might order an ultrasound or a CT scan and tell you where these can be obtained at a very reasonable cash price. You pull out your credit card, check book, or health savings account debit card and pay a very reasonable fee for his services–much less than your most recent car repair bill. You are thankful and reassured that you are in good hands.

You get the test and a few days later, he lets you know that your hemoglobin A1C is a bit high and that you need to lose some weight and restrict your sugar and carb intake to better control your diabetes. He also reassures you that the CT scan did not show any abnormality. A few days out you are feeling much better without any new medication.

These are two choices that are very real, and any thoughtful person would choose the second. In a perfect world, you would have an insurance card that you could tuck away, reserved for BIG medical events. What if this had been cancer or your nausea and abdominal pain were actually a heart attack? The best insurance would be affordable and would only kick in when you need it for a major medical event, perhaps at $5,000.

Meanwhile, the best medical care is obtained from an independent personal doctor that you can actually keep, no matter what the legislators in Washington, D.C., decide is best for you.