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Top 10 Misconceptions in Health Insurance

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Orange County Health Insurance

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Top 10 Misconceptions in Health Insurance
Article contributed by

What do you think are the 10 biggest misconceptions or misunderstood aspects in health insurance?

Here are the Top Ten most common misunderstood and mistakes people either do or think as it relates to health insurance in California.

1 - Insurance Carriers just don't want to pay claims or they can pick and choose which claims to pay.

Fact: By law the carrier must pay all claims that are filed and coded correctly or have been pre-approved.

2 - The insurance company raised my rates and I didn't even have any claims.

Fact- Rates are increased based on age brackets and zip codes. Individuals' claims histories have no bearing on rate increases.

3 - Can I shop and get a better deal from different agents or by going direct to the carriers?

Fact-The price and benefits are the same via agents. They have a wholesale relationship with the carriers. The service they offer is non-biased as they do not work for the insurance companies and thus should not be "selling" one brand over the next.

4 - All Health Insurance includes maternity benefits. I do not need maternity benefits and thus I am wasting my money with health insurance.

Fact-In California there is non-maternity plans which cover all services except maternity. These plans are 30-40% lower in premium

5 - Does my co-pay apply after or before my deductible?

Fact-If you see a CO-pay in your plan benefits this equates to your deductible being waived.

6 - The word "COVERED".

Fact: Very few things are ever "covered" 100%. One example that is covered in plans is a check-up. The word coverage is more appropriate and means that you have benefits and the insurance company will pay part of the bill.

7 - I have a PPO plan and I can go to any doctor.

Fact-Yes you can go to any doctor. However, every carrier has a network of providers. If you stay in this network called "in network" providers your benefits are much better. If you go out of network you still have coverage. However, at a lower tier.

8 - I have a deductible (example $750) and then I have co-insurance of 30%: Does that mean I pay 30% of the entire bill? That could mean a lot of money out of my pocket.

Fact-By definition all insurance plans have an out of pocket maximum for you the subscriber. This is also referred to as "stop loss". Once you hit this next threshold your plans pay 100%.

9 - My Emergency CO-Pay is $100. So, I just pay $100 to go to the ER.

Fact: The CO-pay of $100 is like your office CO-pay of $30. This just processes you into the room. Once the x-ray, stitches or surgery occurs to fix what is wrong your deductible will apply. It will cost you more than $100 to go to the ER. One alternative to help reduce out of pocket expense is the urgent care. These services are typically billed as an office CO-pay and this is a viable alternative for basic services.

10 - What is the difference between and HMO and PPO?

HMO has a primary care physician that you need to see 1st before getting a referral. A PPO plan you can self refer. However, HMO benefits are typically more comprehensive and offer better covered. They lack the flexibility that a PPO offers. The PPO plan typically have a deductible where HMO do not have deductibles.

Article submitted by

At they are here to help. They can answer your questions and help you find the right plan that meets your expectations. The process of finding insurance can and most of the time is a frustrating and time consuming process. They offer patient and understanding help to minimize the time you need to spend to find the right plan. They also have a wholesales relationship with all the major carriers in California including Blue Cross, Blue Shield, Aetna, Kaiser, PacifiCare, HealthNet and others. You can also reach them at 877-840-0554.

** Article submitted by
For additional information on how
Healthcare Reform will affect different people, click The Pros and Cons of Health Care Reform on their website.

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Disclaimer: The above information is presented for educational purposes only. Statements have not been evaluated by the FDA. Products mentioned are not intended or effective for the treatment or prevention of any disease. Consult your physician for all your health needs. is a distributor of information received from many sources and therefore does not make any claims of accuracy. In no event shall be liable for loss or damages of any nature arising out of or in any way connected with such information, including but not limited to, special, consequential, indirect or punitive damages. shall not be liable for errors, omissions or other wrongful conduct of any third party or any provider of information



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