April 2007, Volume 3, Issue 4
Published by AEGIS Communications
Using Your Insurance: Bundles of Joy Reap Unexpected Payout
When Keith Poe, DDS, bought medical supplement insurance back in 1984, he could never have predicted how it would pay off. But big surprises have become part of Dr. Poe’s life—especially 3 years ago when his wife Juli gave birth to quadruplets.
“After the babies were born, I sent a claim form to the insurance company, but I didn’t know what it would pay because routine pregnancy and childbirth are not covered by my policy,” Dr. Poe recalls. He was in for his second surprise.
FOUR BABIES, DOUBLE BENEFITS
Ami Hanson is a claims examiner for Dr. Poe’s MedCASH policy (MedCASH is a group medical supplement plan available exclusively to members of the American Dental Association). Ms. Hanson reviewed Dr. Poe’s claim and quickly realized that this was not a “routine” case.
“I called Dr. Poe and learned that the babies had been born prematurely and were in intensive care for several weeks,” she says. “His wife also had been hospitalized for a month before delivery.”
Because the quadruplets required hospitalization, the medical supplement plan automatically covered each baby for 31 days. Plus, the benefit was doubled for each day of intensive care. The net result: The Midland, Texas, dentist received a check for $120,000 for the babies and an additional payment for his wife’s hospitalization.
“It was quite a surprise!” Dr. Poe recalls. “The money sure came in handy to finish paying off all the medical bills,” he adds, “as well as help pay for the nurses we hired when the babies came home and were on monitors 24 hours a day.”
Although the quads’ birth was Dr. Poe’s biggest MedCASH payout by far, he has used his medical supplement policy a number of times over the years as a back-up to his major medical insurance. “Not only does it pay a cash benefit for each day in the hospital, it also pays a benefit for trips to the emergency room, which comes in handy when you are raising a family,” says Dr. Poe, who also has two older daughters.
“MedCASH is so inexpensive that I figured if I only used it every 2 or 3 years, it would more than pay for itself,” he continues. “And now, after the quads’ claim, I could pay MedCASH premiums for the rest of my life, and they would never equal the benefits I’ve received.”
When shopping for supplemental medical insurance, Ms. Hanson offers the following suggestions:
- Ask if you need a medical exam to qualify. The ADA MedCASH Plan, for example, does not require any proof of insurability for basic coverage.
- Compare the cost of coverage with what it could potentially cost you if you or a family member is hospitalized or has to go to the emergency room. Depending on the circumstances, you could come out ahead even if you file only one claim.
- Look for a policy that pays a benefit no matter what your other insurance or Medicare pays.
- Choose a policy that sends the check to you, rather than to the healthcare provider, so you can use the money any way you wish.
- Find out what’s involved in filing a claim. It should be quick and hassle-free.
- Consider a plan that also pays benefits if you are diagnosed with a critical illness, such as a heart attack, stroke, or life-threatening cancer.
- Insist on a plan that you can continue for many years—for example, to age 90—since your need for this particular type of coverage could increase as you age.
As for Dr. Poe, life with the quadruplets, now 3 years old, continues to be one surprise after the other. “But they’re doing great, and that’s the important thing,” this proud father says.
Editor’s note: Dr. Poe’s statements were obtained by Great-West Life & Annuity Insurance Company, underwriter and administrator of the ADA Insurance Plans, relative to his coverage under Group Policy No. 1107GH-MCP, and reprinted with permission. For more information, visit www.insurance.ada.org or call 1-888-463-4545. This article does not constitute legal, tax, or financial advice; please seek professional input as appropriate to your situation.