LETS ANALYSE THE NIGHTMARE AND SURPRISES YOU WILL FIND WHEN YOU START USING YOUR HEALTH INSURANCE POLICY.

Every single person needs health insurance coverage for those catastrophic issues that can come our way but that luckily are rare. However, as we all know health insurance can be a very expensive nightmare for minor stuff specially if you do not know how they work.

1. What you need to be aware of when you buy health insurance

• Monthly Premium:  This is what you pay every month for the policy. If you are lucky the company you work for pays for it. Or they may pay half and you pay half. Now, no matter who pays the monthly premiums there are “other hidden cost” that you need to be aware of and those come out of your pocket before the insurance company pays a dime for your care and they don’t tell you about. These are, deductible, copays and coinsurance. All of these are different ways that the insurance companies have come up with to make you pay for part of your medical care. This is also a way to discourage you from going to the doctor or hospital since it will cost you money out of your pocket. I will explain them one by one.

• Deductible: This is where they get you big. Depending of the policy you bought, the deductible can amount to $3000, $5000, or even $10000 per person per year! Wow! For any health expense you incur, this amount, you pay out of pocket up front before your company pays a dime. So anytime you go to the doctor office or the hospital, or therapist etc. they are going to ask you to pay your total charges upfront before you get seen until you have met your deductible. And this starts over every year. This is because it is your responsibility and they know if you don’t pay it, they simply are working for free. So be ready for it.

• Copays: This is not as big a chunk but it can bite you good if you see your doctor or therapist often during the year depending on your needs. Most older people see their primary care or their specialist six or more times a year for diferent issues. These copays depending on the policy you buy can be $35, $45 or even $50 per visit! Usually, the higher copays are for specialist visits. So, watch out with these copays, they can add up. They could easily add up $500 or $600 or more per year.

• Coinsurance: This can also bite you big time. I will explain. Let’s say the policy you buy has a coinsurance of 20 percent. What it means is that of every health expense you incur, you always pay 20%. Imagine you go in the hospital for something minor and the total bill is determined it will be $50000. They are going to ask to pay up front $10000.

What I just described in the last four paragraphs boils down to this. Before your insurance company pays a dime for your care in any given year, you not only have to pay your monthly premium, but you also have to pay the total of your deductible, plus a copay every time you visit your doctor, plus your co-insurance if your policy has one. Those last three is where they get you big time, especially if you suffer from a chronic condition. If that is the case, just this can amount to $4000 dollars or more per person yearly. What I have just presented to you is the sad truth about health insurance.

On the other hand, when you are dealing with an insurance focused medical practice you will find that the doctor hardly spends any time with you due to an outrageous decrease in reimbursement and increase in cost of running a practice affecting doctors over the last 35 years. For those reasons, they have to see a huge number of patients daily to cover their cost and make a living. It is so bad that at times you won’t even see the doctor and are seen by a midlevel provider like a nurse practitioner or a physician assistant. Horrible care over all.

2. So what can you do about the nightmare to save money and to get much better care and still have insurance for any catastrophic health issues, which is what everyone worries about and wants the the insurance for?

• You may have heard in the last few years, of many doctors dropping out of insurance companies and opening up what has come to be called “Direct Primary Care” clinics or “Direct Specialty Care” clinics. These are basically subscription type programs in which you pay a modest monthly fee to the doctor and all procedure and treatment they do are included with no deductible, no copay and no coinsurance. Why have these types of practice sprouted all over the place you may ask? Physicians are sick and tired of the “insurance model practice” in which they are allowed only to do what the insurance company deems appropriate or they don’t get paid. Here is an Example: a patient comes to your office with terrible lower back pain, not able to walk without a walker and stating she just lays in bed at home because of the pain. You order a lumbar spine MRI and you discover what is causing the pain, which can be immediately relieved with an injection procedure. You schedule the procedure for next day and the patient comes for her follow up two days later, walking normally with no pain very happy and able to do her chores at home. Success! Happy patient and happy doctor. Well now you as the doctor send the bill to the patient’s insurance company and they decide not to pay you! Why? Because you did not send the patient before the injection, who was in horrible pain, first to Physical therapy for six weeks to see if that would suffice. Wouldn’t you love that torture? Has anyone heard of this kind of example??

• We have developed a Direct Specialist Care Subscription Program for patients with insurances we are not a participating provider of, or patients with no insurance. This program, since our doctor is an interventional pain specialist, is designed for patients with chronic painful conditions that are looking for advance treatments with no addictive substances. All for  $165/month/year for one person, the second person $85/month/year and the therd person $50/month/per year. With that you can schedule as many appointments as you need and there is no deductible no co-pay and no coinsurance. And with this you may opt for some advanced procedure if indicated, that no insurance company pays for them. If you frequently visit a pain specialist or an orthopedic surgeon because you suffer from chronic joint or spine condition and have to pay deductible and copays that your policy requires, our program may be what you need.

• Feel free to share with friends and family or anyone you think may benefit from our services. For an appointment with Dr. Dieguez please call our office at (904) 824-0955.

• For additional information about our office, what we treat and special payment programs visit our website at https://www.theorthobiologicclinic.com/. On our menu click on Biologics + More and on Prolotherapy to check out some of the very specialized procedures we do.

• Also check out our office Facebook page at https://www.facebook.com/TheOrthobiologicClinic/ and also our Instagram page at https://www.instagram.com/orthobiologicclinic/ .

• Our office is located at 811 State Road 206 East Ste #1 in St. Augustine Florida 32086