Why would insurance co. not want to pay for preventive care?

Question

I just found out that our health insurance plan will not cover preventive care (not what we were told when we took this plan). until our yearly deductible is met. This includes any vaccinations my children need, my annual pap smear, etc. Since I just got a $500.00 bill for my children's check up and vaccanations, I will have to forego getting my exam, until we can afford to pay for it. Now we are stuck in this plan until open enrollment, at which time we will be trying to get something else.

I don't understand why would an insurance company rather take the chance of having to pay for the extensive costs of one of their insured becoming ill from a preventable disease than to pay a few hundred dollars for screenings and prevention? What sense does this make?

Answer 1

Contact your local county health department or children/family services office and ask if there is a vaccine program for children who have medical insurance, but their insurance does not cover vaccines. If the shots your children need are the recommended/required vaccines to attend public school your children should be able to receive the vaccines regardless. Generally speaking, the only children not eligible for these types of programs are children who have insurance coverage and the costs are applied to a copay/deductible/coinsurance. It's worth a call to find out. Vaccines can be expensive.

Answer 2

They DO cover preventive care.  Your plan is structured such that you need to meet your deductible.  After that, you will be covered.

If you have a flexible spending account option at work, you should use it to help with the $1000 bill.  I have a $500 deductible.  I put at least $500 into flexible spending each year.  So, while I have to pay for the first $500, it comes from flexible spending (which is taken out in equal installments across my paychecks for the year).

Answer 3

that's what "deductible" means.  you pay the first N dollars of all costs every year, and/or the first Y dollars of each and every bill.

as to why -- because your premium is so low they're cutting corners is why.  the real cost of a reasonably comprehensive family insurance plan is around $1000 per month.

Answer 4

I would imagine that your deductible applies to preventative and medical care services alike.  You seem to give the impression that the deductible only applies to PREVENTATIVE CARE?  That seems foolish, but that does not mean it is not true.  You must call your insurance carrier and inquire  - as them what services apply to the deductible, preventative only or all?

Insurance companies didnt cover preventative care because then 99% of their customers (the insured) would got to the doctors once a year and that would equal more cost for them (even considering illness or preventable disease).  But most have moved away from that and started covering due to state/federal laws and pressure from national 'voices'.

Answer 5

I think that you don't quite understand the difference between something "not being covered" versus "applying to your deductible."

Anything that counts towards your deductible *is* a covered service.  (If the insurer considered it to be "not covered," you wouldn't get the insurer's discounted rate and you wouldn't get credit towards your deductible.  You'd have to pay the entire bill and not have it count towards anything.)

Just because you have to pay for it out of your pocket doesn't mean that its not covered.  

So here's the question...when you say that you weren't told about the way preventative care would be handled when you took your plan, are you saying that you were told that preventative care would be covered?  (Because you do have coverage for preventative care, and therefore were not mislead.)

Or are you saying that you were told that preventative care would not be subject to your deductible amounts?  If you were specifically told that your deductible wouldn't apply to preventative care, then you need to check with your benefits department and see what can be done to rectify the problem.

However, if you just mistakenly assumed that preventative care "being covered" meant that you wouldn't have to pay the deductible first, there isn't anything you can do about that...it was your own misunderstanding.

P.S.  You also have to remember that your employer is the one who sets the deductible level on your plan *and* decides whether or not preventative care is subject to the deductible or not.  The employer has the option to choose whether or not to allow certain preventative services to not be subject to the deductible.  Its not the insurer's decision - your employer negotiated a contract w/the insurer for a certain set of benefits.  That very same insurance company most likely does have plan options where preventative care doesn't apply to deductible - your employer just didn't choose to add that option to their plan.

Answer 6

Your insurance company does cover preventive care, it just goes to your deductible first.  If it wasn't covered you wouldn't receive any discount if you are in a PPO and it wouldn't apply to your deductible.  

As to why it doesn't cover preventive care...Does your auto insurance cover oil changes?

Just a thought ;)

Answer 7

You have two issues here.  The first, as to why they won't pay for preventive care has been addressed above.  The second is that the plan isn't what you were told it would be.  You indicated that you received a summary sheet.  Did that come from your employer, the insurance company or the agent?  Do you still have it?

Your grievance should now be addressed to the party that misled you.  If it were the insurance company or an agent you might have a claim against them.  If it were your employer, you should take that up with them.