A couple I know, who don’t want to be identified, claimed for years that they had great health insurance. They loved the fact that the plan had no premium charges and therefore didn’t cost them a dime upfront. “That works for us,” the wife said happily and often.
And the health plan did work for them, until the husband came down with a mysterious illness that baffled the doctors in his plan’s limited network. One physician whom the couple was counting on for a diagnosis spent months ordering costly tests and then said, “I’m sorry, there is nothing I can do for you.”
Without a referral to the right specialist, the husband ended up spending more than a year and a lot of money bouncing from one ineffective provider to another: from doctors, to chiropractors, to acupuncturists. He didn’t get diagnosed until he signed up for a better plan, with premium costs and a skilled physician who steered him to the right specialist at a major teaching hospital. The specialist knew immediately that he was suffering from inclusion body myositis (IBM), a rare autoimmune disease that leads to severe weakness of the arm and leg muscles.
“We wasted two years when I could have been getting treated,” the husband told me.
As that story illustrates, the most common mistake people make shopping for health insurance is focusing on the plans’ premiums rather than on the overall cost and quality of the insurance. It’s only logical that when insurers collect little or no money from customers up front through premiums, they look to control costs by reducing benefits and their provider networks. In the end, the plan’s limitations can cost you no limit of headaches and expenses.