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How To Pick A Health Care Plan That Covers Your Kid And Won’t Leave You Broke

When was your last doctor’s visit? One time, 5 years ago? Right. And when was your kid’s last visit? Five times last month? Clearly rubbing some dirt on it is practical medical advice for you, but kids need a lot of early preventative care. Preventative care costs money — and if you don’t want that money to come directly out of your pocket you better straighten out your health insurance.

“Kids up to age 10 touch the healthcare system 12 times a year on average,” says Reid Rasmussen, CEO of Freshbenies, a one-stop shop of tools and services to make understanding the American health insurance clusterf–k a little easier. “The average American adult touches the healthcare system 3.4 times per year. Moms have more visits in their 20s and 30s; men start having more in their 40s and 50s.” Basically it all adds up to being very familiar with your pediatrician’s magazine selection.

So how do you make sure you’re getting the best deal with the right coverage? There won’t be any useful answers at the end of your insurance company’s hours-long hold-music. (No Steve Winwood, we’re not “Back in the High Life Again.”) “It’s confusing, there’s a lot of paperwork, there’s no one person to call who’s going to help you,” says Rasmussen. “You look at the cost of a lot of this stuff, and it doesn’t even make sense.” Here are his tips on how first-time parents can navigate the system without having to listen to muzak again.

Trust No One
If you get health insurance through your employer, find out if your employee benefit program includes an advocacy service to help workers get the most out of the system. “I don’t blindly trust everything insurance companies tell me,” says Rasmussen. “To add to that, I don’t trust that any claim/bill/invoice from a doctor/hospital/testing facility is correct, either.”

He says that the healthcare industry doesn’t make it easy for you to ask about their price because that’s not their incentive. If you go to an advocate, they can help you resolve claims or review bills for accuracy. They can also help you shop around for the best price and quality, so you don’t get screwed on non-emergency services like an MRI or X-Ray to find out where the rest of that crayon went.

Go for Broke(r)
No matter what your employment situation or the size of your family unit, you could use an insurance agent who has your back. “My advice is to always use a broker,” says Rasmussen. “A strategic broker approaches their sales in a way that they’re trying to be a consultant and bring a whole suite of ideas for you.” And usually, your cost is the same whether you get their help or not. Consider them the opposite of your real estate broker.

You May Be Over-Insured
There’s such a thing as being too prepared. “Most people overestimate how many bad things could go wrong, and they end up over-insuring themselves,” says Rasmussen. “They’ll go, ‘I could get cancer, I could have this huge expense.’ Things pop up, but in general, most of us in our 20s to 40s only have one bad year every 10 years, as far as medical expenses go.” If everyone’s reasonably healthy, instead of over-protecting your family with the Cadillac of premium insurance plans, it might be better to hold onto that money for now. Or, put it towards any of the other major monthly expenses that your kid eats or poops into now.

Look At The Fine Print
If you look closely at any claim document from your insurance company, you’ll notice that they list 2 amounts: What was billed and what was covered.  And those numbers came from an actuarial’s ass, right?

What’s going on there is that an insurance company will pay a doctor what they charge, unless it exceeds their maximum (aka, the covered amount). When doctors work with a ton of different insurance companies all with different — and constantly changing — prices, it’s easier for them to just bill way over their real cost to make sure the insurance company will pay them fairly.

So where does that leave you? “Ask the insurance company, the doctor, the hospital, etc. if all the listed services are correct, because the rules constantly fluctuate,” says Rasmussen. You might be able to ask them to come down on your bill.”

When Paying More For a Plan Is The Right Move
When your kid’s latest ear infection sets you back another $150 for a prescription, enticingly low premiums and co-pay costs might seem tempting, like keys dangled in a toddler’s face. But, according to Rasmussen, it’s the out-of-pocket maximum that you should be paying the most attention to.

“The average family this year will spend $3,600 in out-of-pocket medical costs: Doctor visits, urgent care centers, etc. That’s not their insurance premiums, that’s out-of-pocket as a family,” says Rasmussen. Do the math based on your own family’s typical expenses. If you’re between a low-cost monthly plan and a higher-cost one that lets you max out on those out-of-pocket costs more quickly, the latter could be the way to go.

How To Choose Health Care For Your Family

Take Some Supplements
Consider a supplemental accident plan. This type of add-on stipulates that if you have a medical cost as a result of an accident (which is basically a toddler’s raison d’etre), the insurance company will help you cover what you’d typically have to pay yourself.

“Be very honest about what out-of-pocket costs you can really handle,” says Rasmussen. “If, say, it’s $10,000, and you know you don’t have that, it might be worth spending $15 or $20 more per month [for an accident plan].” Sure it’s an extra cost, but it beats ponying up your entire life’s savings on a swan dive off the big kid slide.

Call the Doctor, And Leave It At That
Kid ailments can strike at anytime, including 1 AM on a Sunday. (Actually, always at 1 AM on Sunday.) The average pediatrician isn’t taking your call at that time of night. Even if it’s not an emergency emergency, like no head-spinning or crawling on the ceiling, your only option might be a trip to the Emergency Room. Look into an insurance plan that includes phone or email access to a medical professional 24/7. They can even occasionally call in prescription in the middle of the night. Because you watching Maury Povich and drinking vending machine coffee is usually worse than your kid’s ailment.