You only think you’re Covered

This was the title of a Time magazine piece by Haley Edwards a few years back that included a profile of a case in our practice. The article came to mind through a recent personal experience I wanted to share.

Seven weeks ago I sustained a catastrophic plumbing accident in my home, a condo I moved to two years ago when I downsized. Accidents happen; I’ve replayed the situation a hundred times, each time making different decisions that wouldn’t have resulted in the significant damage to my home. But in insurance parlance, I sustained a “loss.”

In the early days after the disaster I was calm because I knew I had homeowner’s insurance and had been thoughtful about setting the limits for my coverage so I would have enough coverage, but not more than I would need. I knew a disaster would be disruptive, but no had died and “things” can be rebuilt and replaced.

But after the moisture had been dried up and the damaged structure and contents removed, I had the experience we too often have in the healthcare world when someone shows up with a clipboard and says “Sorry, your policy doesn’t cover that.” 

In a second everything changed. I wasn’t covered. Or at least not covered enough. I couldn’t imagine how an insurance agent could have let me set my coverage limits so low. Or why I hadn’t done a better job of understanding how insurance in condos is different than insurance in a freestanding home.

I didn’t sleep for several days, and as the awareness dawned that if I wanted to restore my home to what it was, I may very well be paying for a lot of it myself.  And it wasn’t going to be cheap.

My story has a moderately happy ending. As it turns out I did have enough coverage; courtesy of my homeowner’s claim adjustor, the person who turned out to be my “insurance advocate,” there was other coverage available I didn’t know I had. Insurance doesn’t prevent bad things from happening; its purpose is to restore things, based on your coverage, to where you were before the bad thing happened. It didn’t make the loss go away, but it at least should mitigate some of the financial damages.  

How does this relate to healthcare?

My experience with this flood is akin to the experience we have when we access the healthcare system. When we have insurance, we think we’re covered. Until we find out that might not be the case.

The reality for most of us though is that we don’t really like to deep dive into what kind of insurance coverage we have until we have to use it. This is part of being human. No one wants to focus on worst-case scenarios.

How About a Talk Back?

I wrote about the “talk back” a few issues back. It applies not just to conversations with our doctors but also with our insurers or their representatives. If you’re reviewing your health insurance coverage, or transitioning to a new plan, consider seeing if you can “talk back” with a trusted partner what happens in the event of a serious loss (at least generally). Understand what your financial risk could be that you’re buying insurance to mitigate, and “try on” how dealing with that worst case scenario would feel.

But if you don’t do that, you’re not alone. I didn’t do a “talk back” with my homeowner’s insurance agent. Like most of us I assumed because nothing bad had happened in the past I could trust my agent and go with what they recommended. I’ll be having that conversation again soon, though, and since I know I need to make changes you can be sure I’m going to talk back before I sign on the dotted line.  And I’ll be doing the same thing when I re-up for my health insurance this year.

I have a new sense of emotional comradeship with what consumers feel when that medical bill shows up and they thought they were covered. Empathy can’t always fix the problem, but it goes a long way toward starting to generate options. Please call if you want to do a “talk back” on your health insurance.

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