A few years ago, I grew an award winning kidney stone. The only way to eliminate the pain was to have it surgically removed. It was too big to pass into my bladder on its own without help.
This was not my first experience with a kidney stone. I knew what to expect, at least physically. However, when I got to the hospital, I was surprised. The nurses and technicians who did my pre-surgery work-up were very kind and easy-going. They took their time to tell me what was going to happen throughout my entire medical treatment. I left their facility with all the confidence in the world.
My next stop was at the business office. It was then that I was shocked back into reality. Like most Americans I can only afford a health insurance policy with a high deductible. As long as I am able to go to my doctor’s office, the deductible is meaningless to me. I just pay the co-pay at the doctor’s office and again at the pharmacy and in a couple of days I am back on my feet and ready to do what I do.
MY EXPERIENCE AT THE HOSPITAL
I learned, the hard way, that is not the way hospitals work. If you are not in the Emergency Room, they require proof that you have already paid your health insurance plan’s deductible. If your insurance company cannot confirm that you have, the hospital will require you to pay your full deductible up front. At least the hospital I to which I went did.
I do not know about you but I can be pretty tight with money. If you hear a scream that you cannot explain, there is a good chance that I am pinching the picture of Lincoln on the penny just a little too hard. I know that it is a flaw in my character and something I am working on.
WHY IS GAP INSURANCE NEEDED
I am a licensed Insurance Counselor and insurance agent. Supposedly, I am more than just a sales person. I am supposed to know how insurance works. In the last few years more people have elected to get health insurance plans with deductibles of $ 1000 or more. The deductible I have is $ 2500.
I knew that the hospital was going to ask me about the deductible. I was prepared to pay it in installments but the hospital I went to wanted a check for the full $2500 before they would allow their rooms to be used for the removal of my kidney stone. Since that stone caused the worst pain I have ever felt in my life when it moved, I had no choice but to write that check. I don’t know whether my kidney or checkbook hurt worse when I wrote that check for $ 2500.
Since that time, the insurance industry had developed a “Voluntary” benefit to help employees whose employers have elected to offer them only plans with high deductibles. GAP plans help the employees when those major hospitalizations and medical treatments pop up.
As of today, GAP plans act to reimburse members for their expenses rather than pay money directly to hospitals. In other words, I would still have to write that check for $ 2500. The difference between today and then is that if I had a GAP plan today, I would be reimbursed for the $ 2500. Without a GAP plan, that money comes out of my checking account and nobody pays me back.
LIMITATIONS OF GAP PLANS
Currently, the only GAP plans of which I am familiar are offered as a “Voluntary” benefit to companies with 5 employees or more. If you click on the photo that accompanies this post, you will learn more about them.
Unfortunately, although I do work with a couple of companies with more than 5 employees, most of my clients are individuals who either own their own companies, work for companies that have no benefits or are dependents who have found that an individual plan is less costly than a group plan. None of these individuals qualify for the GAP plan.