The American healthcare system is about as straightforward as quantum physics explained by a toddler. Here's the simplified version:
You pay premiums every month to have health insurance
You still pay when you go to the doctor (deductibles, co-pays, coinsurance)
Some things are covered, some aren't, and the list changes regularly
Nobody can explain your bill, not even the people who sent it
Somehow, this is considered normal
Our job is to make this system slightly less insane for Monroe NC residents and businesses.
What Our Health Insurance Options Actually Cover
Most people don't discover what their health policy actually covers until they're sitting in a hospital gown wondering if that procedure the doctor just recommended will cost more than their car.
Let's cut through the nonsense and explain what health insurance options typically cover:
Individual & Family Health Insurance
For people who don't get coverage through work, or who want better options than their employer provides. These plans cover:
Preventive care (annual check-ups, vaccinations, screenings)
Doctor visits (both primary care and specialists)
Emergency services (for when your DIY project goes horribly wrong)
Hospital stays (because hospital gift shops and TV rentals aren't expensive enough)
Prescription drugs (with a formulary more complex than the tax code)
Maternity and newborn care (because having a baby shouldn't require a GoFundMe)
Mental health services (because sometimes the healthcare system itself causes anxiety)
For businesses that want to attract and keep employees without resorting to foosball tables and free snacks. Group plans typically offer:
More affordable rates than individual plans
Tax advantages for both employers and employees
Similar coverage to individual plans, but often with better networks
Options for employers to contribute to premium costs
Potential for additional benefits like vision, dental, and life insurance
Medicare Supplements & Advantage Plans
For those over 65 who discover that Medicare alone has more gaps than Swiss cheese. These plans help cover:
Deductibles and co-payments that Original Medicare doesn't cover
Prescription drug costs (because apparently gold is cheaper by the ounce than some medications)
Additional services like vision, dental, and hearing that Original Medicare ignores
Out-of-pocket maximums to prevent medical bankruptcy
Because apparently teeth are luxury bones that require their own separate insurance. Dental plans typically cover:
Preventive care (cleanings, x-rays, check-ups)
Basic procedures (fillings, extractions, root canals)
Major procedures (crowns, bridges, dentures) after waiting periods
Sometimes orthodontics, but usually with more limitations than a prison yard
What Health & Dental Insurance Typically DOESN'T Cover (The Fine Print Nobody Reads)
Experimental Treatments
If your doctor suggests a treatment that was featured on "60 Minutes" last week as a "breakthrough," your insurance probably considers it "experimental" and won't cover it.
Cosmetic Procedures
Insurance companies believe that looking better is a luxury, not a necessity. Unless you can convince them that your procedure is medically necessary, you're paying out of pocket.
Out-of-Network Care
Most plans have "networks" of providers who have agreed to their rates. Go outside that network, and you might as well hand your credit card to a toddler at a toy store.
Pre-Authorization Requirements
Some procedures require insurance company permission slips before they'll cover them. Skip this step, and you might be funding your surgeon's next vacation home.
Alternative Therapies
Acupuncture, chiropractic care, and massage therapy are often limited or excluded, because apparently if a treatment has been used for thousands of years, it's still "unproven."