Op-Ed: If Your Health Care Bill Doesn't Seem Right, Check with your Broker

Anyone who has ever taken a loved one to the emergency room for treatment knows it can be harrowing. After dealing with lines of people, mandatory paperwork and the nervous waiting, most people are just relieved to finally see an actual live doctor enter the exam room.

At that moment, the farthest thing from your mind is to ask if that physician is in your network. And that question still doesn’t seem that relevant if, say, a radiologist is brought in to look at an X-ray, or if the on-call anesthesiologist is needed.

But reality comes crashing in the mail one or two weeks later, when those specialists send you bills for hundreds, if not, thousands of dollars of services you assumed were covered under your health insurance plan. You figured the ER asked for your insurance card; why would they send in all these doctors who don’t accept your plan?

Time to panic, sell the car, cash in your pennies - not so fast. As a health insurance broker, and a member of the New Jersey Association of Health Underwriters, I’ve often been able to help in getting these issues resolved.

Just because the medical provider and your HR department tell you to pay the bill, if it doesn’t seem right to you, check with your broker. Health insurance brokers continue to play such a huge role in New Jersey as consumer advocates.

Brokers are the ones who frustrated policyholders call in to play mediator between the hospitals and the insurance companies. We read the fine print, and ensure patients and their families are not caught paying a nickel more than they are absolutely required to.

This is an important message as insurance companies across the country are adjusting commissions on new sales of individual health plans on April 1 as part of cost-cutting moves.

This move is taking place after last year’s major decision by UnitedHealth Group, the country’s largest health insurer, to scale back on commissions after announcing it lost more than $700 million on sales of “ACA-compliant” individual plans.

We are pleased to see that insurance carriers in New Jersey recognize the critical importance of brokers. It is questionable how these out-of-state insurance companies can sell their plans without the benefit of brokers whose job is to:

• Be proactive and provide complete information about benefits
• Help select the right programs, coverage and get the best rates
• Give ideas of benefits implemented with other employers
• Continue to review providers and ensure the most competitive benefits
• Educate employees on the benefits and various aspects of financial planning

Brokers are among the few who understand the trends in the market, which is constantly changing because of the roll out of the Affordable Care Act.

Even as we contemplate more changes in health insurance, more and more regulators and legislators are realizing the critical importance of the health insurance broker. Buying health insurance isn’t like buying a sweater online; you can’t return a mammogram. Licensed insurance professionals must continue to be the navigators of any purchase of health insurance.

When in doubt, you can always contact your broker directly and get the information you need.

Jack Kalosy is a member of the New Jersey Association of Health Underwriters and is a health insurance broker with SASCO Insurance Services, Inc. of Hackettstown.