Insurance Deductibles for Dummies

Insurance explanation of benefits: note the circled phrase.

One of our warmer, fuzzier staffers has been known to say that there are no stupid questions, but even she was taken aback by the utterly ridiculous question expressed by someone in today's nominee. Although we tend to give credit where credit is due, there is no way we (without access to NSA records) could find out who originally asked "How to Meet a Health Insurance Deductible." On the other hand, we do know that Kendra Dahlstrom tried to answer it for AZCentral.com. That's one of the sites that bought content from Demand Media, which is why the post showed up in a site:eHow search...

The answer, in case you're the OQ, is pretty simple: Have medical bills – probably lots of them. We'd like to think that anyone pretending to answer that question, especially in more than 400 words, would explain that the deductible is out-of-pocket expenses the insured must pay before insurance "kicks in." Dahlstrom neglected to mention that definition...

Oh, sure, Kendra made the requisite noise about researching your plan, saying that,

"Some plans have deductibles only for surgical procedures or hospital visits. Others have deductibles for every single type of health care you receive..."

...which we're pretty sure isn't much help. Dahlstrom also shares this dubious information:

"Visit doctors who are in your preferred network... If you stay in this network, your deductible will probably be smaller than if you travel outside to another doctor."

She confuses in-network and out-of-network co-pays with deductibles there, not to mention her misuse of the word "travel." Dahlstrom next meanders through the idea of individual and family deductibles which, surprisingly enough, she manages to get right. Finally, Kendra attempts to explain the dreaded EOB, about which she says,

"Pay the health care provider the exact amount shown on the explanation of benefits..."

...which is a little strange, since the explanation of benefits almost always includes some version of the words, "This is not a bill." You pay the provider's bill, not the insurer's explanation of benefits: the bill includes an account number so your payment is credited correctly, and a remittance address so your payment goes to the right place. Idiot.

Dahlstrom concludes with the following "tip":

"Many plans have an emergency room deductible that can never be met. You may have to pay a $50 or $100 deductible, on top of your regular deductible, every time you visit the emergency room."

Someone seriously needs to explain the concept of co-pay to Dahlstrom, otherwise even her insurance company will be giving her awards. Wouldn't it be funny if Blue Cross or United Healthcare sent her a plaque naming Kendra their Dumbass of the Day?

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