Residents of Santa Clara and San Mateo, Beware of Health Insurance Issues!

It is not healthy to worry needlessly about your health. However, ignoring the signs of potential health issues is even worse. Hypochondria is not a good thing – but health is, in many ways; it is just a matter of common sense and taking essential precautions. The same wisdom applies to the matter of health insurance.

The right health insurance coverage for your family is critically important. It requires your time and attention as well as expert advice. If you have already gone through the mill, that should be okay. Unfortunately, the word ‘should’ has to be used here.

That is because recent changes in health insurance policies and procedures could catch you unawares and affect adversely the handling of a possible future medical situation. Here is a case in point that could have major implications for those living in Santa Clara and San Mateo.

An unexpected ineligibility of coverage

In Santa Clara and San Mateo counties, Stanford is a major provider of healthcare services. It runs one of the two trauma centers in Santa Clara too. Those who purchased an Obamacare health insurance plan after 03-01-2011 with Blue Shield do not have Stanford as a preferred provider.

This has serious financial implications for those living in these counties. If the health insurance company has a preferred provider contract with a hospital or other health facility, the full benefits of the insurance policy are available.  This typically involves a 20% patient copayment after a deductible, which is set to an annual out of pocket limit; it is usually $7,550. The preferred provider has a set fee for each service it provides.

Those with policies purchased after 03-01-2010 will have to pay much more if they go to a Stanford facility. The deductible is double and the copayment rises to 50% of the covered charge. On top of this, the patient will have to pay for uncovered charges.

As an example, take a surgical procedure that costs $100,000. With a preferred provider, the patient pays just the out of pocket of $7,550. Everything else is covered. For the same procedure with a nonpreferred provider, the out of pocket becomes $15,100 and the copayment is $50,000. In other words, the patient will have to pay $65,100 out of the total cost of $100,000.

Those who have policies purchased before 2010 or have Medicare supplements may not have to face this adverse situation caused by this new development.

Where do you stand?

If you live in Santa Clara or San Mateo counties, you should examine carefully your health insurance policy to see if you have the proper coverage you need. Those who live in other counties should also check, if there have been any recently introduced changes that might affect them.

You need to act fast in order to modify or change the policy, if required, and to provide for the best coverage your family deserves. It would be better for you to contact at the earliest an experienced insurance broker, who will be able to give you the guidance you need; ensure that you have made the right decisions.


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