Frequently Asked Questions

 
 

Our most frequently asked questions can be found here.

Have Other Questions? Contact Us »

 

What is the difference between deductible, co-insurance, and Out of Pocket Maximum?

Please see our video for an in-depth 1 minute explanation!

 

What is the difference between supplemental insurance and medical insurance?

Medical insurance is your first line of defense, and supplemental insurance is your second line. Medical insurance should take care of the giant bills that arise (MOOP), and supplemental insurance takes care of you by paying a lump sum benefit in the event of any critical illness. So if you do happen to get a diagnosis of cancer, heart attack, or stroke, (the list goes on) critical illness will pay you money to cover all the other costs that arise, such as bills during the time you can’t work, money to go towards doctors or medications that aren’t covered, travel costs, and staying afloat, etc.

Unfortunately, about 7 out of 10 people who only have medical insurance end up going bankrupt if they ever have to use it, due to the many unexpected/hidden costs that quickly arise when something goes wrong. Supplements protect you financially, and drastically help prevent any critical illnesses from affecting you or your loved ones.

 

What’s in/out of network?

A network is the doctor, facility group, or hospital(s) that accept your insurance. It’s ALWAYS better to go to an in-network doctor over out of network. An HMO like Kaiser has set facilities that only accept Kaiser, and a PPO like Blue Shield has a range of facilities that accept Blue Shield, and if you go to one that doesn’t, you will be billed under the “out-of-network” column.

 

Is Chiropractic covered?

Unfortunately, no under the Affordable Care Act they are not covered. Some people have luck utilizing their Physical Therapy benefits to pursue their needs.

 

I have Covered California. What should I do if my income changes?

If you expect your income to change by more than 5% we recommend that you touch base with us to ensure that your pricing is still within your budget.

 

When can I change my plan?

You can cancel your plan at anytime. To change plans, you will need to wait until the open enrollment period which typically runs from November to December. However, if you have a recent qualifying life event such as loss of health coverage, change in employment, change in address, or recent marriage/divorce, you may be eligible to change plans or enroll now.

 

What’s a copay?

Anything listed on your plan PDF that says “$ per visit” is a copay. This is the set amount you pay to an in-network provider. This covers your conversation with the provider only, and any additionally recommended treatment will fall under the corresponding category.

A common misunderstanding is the ER copay—if the ER copay is $350, that’s your copay to enter the building; however, if that ER visit results in admission to the facility, especially overnight, then you will face your deductible, co-insurance, and out of pocket maximum. Also remember that Urgent Care is cheaper, and similar to the emergency room, so consider your options beforehand. However, I am not your doctor; so if you have a medical issue, don’t mess around and go get help!

 

Where can I find my network?

Blue Shield members

Kaiser members

Anthem Blue Cross members

Oscar members

Molina members