What Happens If I Get Sick Or Hurt?

A few years ago, I left my corporate job to go out on my own as a contractor in business development and marketing. I was excited to work for diverse companies and be self-employed, but had no idea what it would be like to be responsible for finding healthcare on my own. I was offered a COBRA plan and had sticker shock… there was no way I could afford the monthly payment as a newly self-employed professional. I was hopeful the marketplace would be my answer only to discover high monthly premiums and even higher deductibles. I considered myself a good researcher and informed healthcare consumer, so how could I not find a decent plan? Thinking about it, I wanted more than a decent plan — I wanted a quality plan that I could rely on for everyday types of needs and if a major medical incident occurred. I turned to my freelancer & small business owner friends to inquire about what they do. I heard the same response, you either pay 3x the rates or go without healthcare.

Does this story sound familiar?

My experience was the catalyst for delving deep into the world of health insurance and trying to understand if finding a quality affordable plan was possible. I spent months exploring and talking to companies that touted their affordable rates, but with skinny plans and limited networks, this was not for me. I also want to preface that I was above the age of 40 and my income was not qualifying me for subsidies, but I still was not in the tax bracket to afford over a $500 a month payment.

When I finally found a solution, I said “What’s the catch?“

It just seemed too good to be true. With transparent pricing, a concierge team to walk me through health needs, and an affordable monthly & annual out of pocket, I just didn’t think anything like this existed.

I have never heard of a healthshare before and had many concerns. The first concern was that it would be there for me if something major happened like a dreadful disease or if I was hospitalized. Secondly, could I really see any primary care provider or specialist? Lastly, would I have to pay and large medical bill and wait to be reimbursed? I didn’t jump to enroll so quickly, since this was a new concept I wanted to research the industry. What I learned was that it’s just like with insurance — it’s not a “one size fits all”.  Each healthshare functions differently and I was seeking particular benefits.

• I wanted to make sure there were no lifetime or annual caps. I didn’t want to be kicked out of a hospital or my treatment be delayed because I reached a $250,000 cap.
• I wanted to be able to know what I would owe if I needed surgery or if I had to see my primary care physician.
• I wanted to know what my max annual out of pocket would be and if I’d have the same benefits state to state.

I found all of the above and more in a plan. In addition to the low monthly and annual out-of-pocket, the plan included unlimited primary care, mental health, annual wellness, 12 chiropractic visits, 24/7 virtual health, and dental + vision. It also included a “care team” that was there around the clock to help with navigating my health need, from a sore throat to second opinions.

When I enrolled, I was nervous. This was new for me; I have used traditional insurance all my life. I was used to being mailed my insurance card, having a group number, and knowing what my co-pay would be. I was trained to pick up the phone and call the insurance company to go over plan benefits & what my responsibility would be if I went to the ER, needed surgery, or just wanted to see my internist. The expectations of being with insurance were basically already set. I have been through a system and understood there were claim codes, co-insurance, a network of providers, and sometimes billing would be off, and then there are the phone calls back and forth to straighten it all out.  For instance, I had surgery one year and discovered one month later when the bill came that my anesthesiologist was out of network. A $1,500 bill arrived! The furthest thought in my mind when being knocked out for surgery is, “I wonder if this anesthesiologist is in my network?” When they weren’t, I had to deal with this unanticipated bill.

I am grateful that I had insurance and grateful that there are options out there, but for many of us, we can’t budget for a platinum plan (or even bronze in some cases). The average family pays $1,500 a month for the premium &  deductibles range from $6,000 to $16,000. That can be over $35,000 in healthcare costs if a major need occurs.

Not to mention there are plans that do not include prenatal or delivery. A family newly pregnant is left searching for a plan with coverage, and pregnancy could be considered a pre-existing condition. This is when indipop gets a call from a very frustrated person who should be concentrating on staying healthy and stress-free, not dealing with finding a plan to bring new life into the world.

Healthcare is not perfect

I wish healthcare were perfect. I have heard the horror stories of waiting years to get a mammogram because a person was uninsured, only to discover stage 3 breast cancer. Or the emergency appendectomy that they will be paying off for a decade, or the person who thought they were “covered” only to discover that when it is not deemed an emergency surgery it is not included in the plan.

For a majority of people, they just want a plan in place for the worst-case scenarios… they consider themselves healthy and rarely go to the doctor. They see an affordable monthly rate and a low deductible, click the button, and enroll. They go about their daily lives and sleep well at night not thinking about the what-ifs. Until one day they are rushed to the hospital with an aneurysm. Emergencies are not the time to figure out what’s included in your plan; it’s a time for recovery! It is important to understand the guidelines, fine print, or policy documents to ensure no surprises if this type of emergency occurs.

Another approach to managing medical needs

I understand the hesitation about enrolling in insurance or a healthshare. The research, the costs, and the guidelines can be confusing. Personally, I  wanted something simple to understand. Since healthshares function differently than insurance, I had to learn a new approach to managing medical needs. At first, I had to get used to using an app or calling one main number to guide my care, but now I can’t imagine not having this care team. It is getting concierge care without the VIP cost.

This is my own personal story of one of my medical needs this year.

I woke up with what I thought was pink eye. I used the app and filled out what my medical need was. I answered a few questions:  when did it start, did anything make it feel better, etc. Within minutes I got a text asking “Is this a good time to contact you, Melissa?” Yes, it was. I was not an ID card but a person needing care. I explained my symptoms and they asked me to upload a picture of my eye and If I would like a provider to call me at 11 am. At 11 am I spoke with a provider who asked me questions about my overall health and my eye. They said it does look like conjunctivitis and asked me if I would like a prescription called into my pharmacy. By 11:30, I had my eyedrops and the total cost was $10 for the prescription &  $0 for the virtual visit. I can’t put a  price tag on the amount of time I saved by not waiting in a waiting room or trying to get an appointment with a provider.

This was a minor everyday kind of health issue, but what happens if I need an unscheduled surgery? The healthshares that indipop partnered with all have set pricing for these major medical needs. That means for an appendectomy, I will be responsible for $1000 for the entire need, regardless of what hospital, what provider, or what anesthesiologist was on call that evening. Having transparent pricing is part of how healthshares function. They have a health care blue book that includes the costs of health needs, covering everything from a visit to your dermatologist to MRIs in the hospital. They can drill down by zip code to ensure you are always paying a fair rate for a medical need. You have a set amount on the front end, and on the back end, they do what they do best and negotiate the medical bill. The bill is then shared among a “community”.

The “community” is essentially a fund that is being managed and monitored to ensure medical needs are being paid. Your medical need is private and members do not know who is being treated. It is not just about the cost of care that is attractive with a healthshare, but the “patient first” approach for care. The indipop healthshare partners want to make an impact in the healthcare industry and provide stellar customer service to ensure you are getting the care you need while managing the cost at a fair price. They put the care in healthcare. It is refreshing to not feel like an ID card, but an actual person needing care.

Options are a good thing.

99% of people indipop speaks with did not know these plans existed. It is not a unicorn plan for everyone and we don’t shout from the rooftops everyone should switch to a healthshare, but these plans are out there. Knowing you have options when life changes occur such as planning a family, getting a divorce, or leaving a company to start your own business is stressful enough. indipop is here to help save you the time and energy of researching dozens of plans and can walk you through your options.

If you are uncertain if a healthshare is right for you or you would like to learn more about indipop plans, please schedule a call and we’ll be happy to help!