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Insurance Information

Waisbren Medicine

In response to the Affordable Care Act, otherwise known as “Obama Care,” many health insurance companies have modified their available policies such that the burden of payment for health care has shifted to the insured individual.

Question: Has Medicare Changed?
Answer: No. Medicare is now the best insurance you can have, so long as you also purchase a Medicare supplement policy.

Question: Have the other health insurance policies changed?
Answer: Yes. Since January 1, 2014, the price of most commercial health insurance policies has increased, while coverage has markedly decreased. Because of newly required deductibles and co-payments, most patients with commercial health insurance policies will find themselves paying, out of pocket, for a much larger percentage of their yearly doctor bills. For example, some Affordable Care Act (“ACA”) insurance plans have a $2,500.00 dollar individual deductible. The family deductibles are twice the individual amount, for many “Obama Care” plans.

Question: What is a deductible?
Answer: A deductible is the yearly monetary threshold after which an insurance company pays your medical bills. If your deductible is $500 dollars, then the insurance company will not pay for $500 dollars of medical bills that you receive, each year. The deductible must be paid, out of pocket, by the patient, in addition to any co-payments, before the insurance company assumes any responsibility.

Question: What is a co-payment?
Answer: A co-payment is the amount you must pay, out of pocket, for each physician office visit. The co-payment is never covered by insurance and your doctor is required to collect the full co-payment at the time of each visit. A co-payment may be as small as $5 dollars, or as large as $50 dollars, or more, depending on the insurance policy.

Question: What is co-insurance?
Answer: A co-insurance policy pays a fixed percentage of the medical bill, after a deductible (if any) and co-payment (if any) are paid. An example of co-insurance is a Medicare supplemental insurance policy that pays 20% of the allowable Medicare charge, after the yearly Medicare deductible is met.

Question: Is there anything I can do to avoid high deductibles and co-payments?
Answer: Yes. You can select a high quality health insurance plan. Such a policy will cost you more in monthly premiums, but will likely save you money, in the long run, if you need any medical care during the year. The best insurance plans, including some Obama Care plans, have no deductible.

Question: How has Waisbren Medicine adapted to these recent changes in health insurance coverage?
Answer: At the time of each visit, we request payment of the co-payment and full payment of any overdue balance, before a patient sees the doctor. In cases of financial need, our billing service has been authorized to set up a payment plan.

Question: Since I may be paying, out of pocket, for much of my outpatient care, should I simply not bother buying health insurance, and just take my chances, with my health, until I go on Medicare?
Answer: No. The Affordable Care Act requires everyone to carry health insurance. Commercial health insurance policies, especially those with high deductibles, should be viewed as “disaster insurance.” As such, commercial health insurance would protect your family from the enormous bills that a hospitalization would generate. It is not uncommon for a single hospital stay to generate a bill in excess of $100,000.00 dollars. Without health insurance, a hospital would likely put a lien on your home or attach your other assets in order to collect its bill.

Question: If I have testing done at the hospital or at a hospital-owned clinic, would I save money?
Answer: No. Hospitals, and hospital-owned clinics, are allowed to charge a “facility fee” in addition to the standard fee, for most diagnostic testing. The bill for a test performed in a hospital clinic or in the hospital, itself, would be around 40% more than in a private office such as ours.

Question: What if I need diagnostic tests, but cannot afford them, even at Waisbren Medicine?
Answer: Patients who cannot afford diagnostic testing are referred to Deborah Heart and Lung Center, a New Jersey charity hospital, where such tests are provided without charge to the patient.

Question: What if I cannot afford office visits at Waisbren Medicine?
Answer: Patients who cannot afford to be seen at our office are referred to the Volunteers in Medicine Clinic, where free outpatient care is available.

Question: Who may I call if I have any questions about my insurance policy or my bill?
Answer: Questions about your bill should be directed to our billing service. Questions about insurance plans or our office policies should be directed to our office manager.