Using Health & Accident Insurance As A Full-Timer
Disclosure: The company mentioned in this post did not sponsor us.
Health insurance is one of the most difficult things we have to deal with living on the road. We’re still on the search for the best health insurance as self-employed full-timers. But this post isn’t about all the health insurance options available; there are a lot of articles on that topic already. This is about my experience using health and accident insurance as a full-timer, for a recent injury that required surgery.
Jerud and I were still residents of North Carolina with ACA health insurance when we hit the road. After ~two years, I changed mine to Liberty HealthShare because my health insurance with North Carolina increased a lot. I left Liberty after a year because their prices also increased, and they don’t cover birth control pills. I then went back to ACA – this time through Nevada’s marketplace since we became residents there in the fall of 2018.
At my income range, the plan options I had were pretty sad. They were all HMOs and the costs started around $120 and went to $200+ a month. Plan deductibles were mainly in the thousands. If there was one that was below $1,000, then the premium was really high. I ended up choosing an HMO from Health Plan of Nevada, and it costs me around $125/month with a deductible of $6,600. HMO plans limit the doctors and medical facilities that my insurance actually covers. The doctors and facilities that are in-network with my insurance company are all in the state of Nevada, and out-of-state coverage is limited to medical emergencies. From my understanding, this is what most of the marketplace options are for most states.
Ching backcountry snowboarding in the Tetons.
The thought of not having the easiest access to doctors didn’t really faze either of us. Both of us are very healthy. We don’t ever visit the doctor (except for a gynecologist checkup every three years). Neither of us are on any prescription drugs (aside from birth control pills – but I got an IUD this year, which was actually covered by my regular insurance). Yes, we’re active in the outdoors, but we don’t do extreme sports. We figured being mobile meant if we need to see a doctor, it’s because we’re choosing to see a doctor and can drive to Nevada. Despite that working out in previous years, it’s not what happened this year.
Jerud and I spent the winter of 2018/2019 in Teton Valley (Idaho) so we could snowboard and get into backcountry touring. After a little over two months I got hurt while backcountry snowboarding. I ended up completely tearing my Achilles. Luckily, I had already started a supplemental (aka accident) health insurance plan: Accident ExpenseGuard with UnitedHealthcare. Despite having done all my research, never having used this kind of insurance before I wasn’t totally confident they would actually pay out for this accident. From my previous experiences, insurance companies always try their hardest not to pay out. I debated whether or not I should go to Nevada to have my Achilles surgically repaired. But that would’ve been logistically chaotic since the Toaster was stuck in a haybarn covered in snow and there would be months of follow-up visits. Unless this company was a total scam, there wasn’t any reason why they wouldn’t cover my medical expenses. So, I took a chance and got my surgery done in Jackson, WY.
UnitedHealthcare Accident Insurance Plans
UnitedHealthcare has three accident insurance plans: Accident ExpenseGuard, Accident ProGuard, and Accident ProGap. The basic differences between the three of them are:
Post Achilles surgery
Accident ExpenseGuard: Basic accident insurance
Accident ProGuard: Basic accident insurance plus coverage for critical illness
Accident ProGap: Covers basic accidents, critical illness, and hospital admission
Accident ExpenseGuard has three level plans:
$10,000 coverage: as of 2019 it was $39.70 monthly premium
$15,000 coverage: $46.99 monthly premium
$20,000 coverage: $52.21 monthly premium
The plan has a $250 deductible. I purchased the $20,000 coverage plan.
The way the plan works is that I submit all my medical claims to them and, if approved, they pay out directly to me. I wasn’t required to visit an emergency or any medical facility prior to using this plan. Trust me, it sounds way easier than it was. Shortly after my accident, I called United Healthcare asking for the exact paperwork I needed to submit with my claims. Despite following their instructions, it wasn’t until almost two months after I sent in my initial batch of claims that I found out I also have to provide them my medical records and chart notes from each medical facility. They notified me of this through the mail – the worst way to communicate for a full-timer!
One of the biggest downsides of the accident insurance plan is that everything has to be submitted via snail mail or fax. The plan doesn’t provide its customers an online account. All communications are done through mail, fax, or sitting on the phone for way longer than I have the patience for. I initially mailed everything through the post office (because who actually has access to a fax machine?). But when I called a month later to follow up on the status of the claims, I found out the claims department somehow only received part of the claims I submitted, despite them all being in the same envelope! The trips to the library to print my records out and going to the post office, only to be moot, started to frustrate me. That’s when I realized the joys of efax!
Submitting Claims
Here is what UnitedHealthcare’s claims department needs:
Accident Indemnity Claim Form: Call UnitedHealthcare and ask them to provide you the URL for the form for your specific plan
Superbills: Ask your medical provider to email you a bill with an itemized list of services you used (also known as a superbill). Insurance requires the following information to be included on the bills:
Health provider’s name
Health provider’s address
Federal tax ID
Date of service
Diagnosis code
Procedure code (CPT code)
Fee
Patient’s name and information
Medical records/chart notes: Such as admission notes, consulting notes, and visit results.
I highly recommend sending everything via efax. I used eFax and MetroFax, both of which offer free 1-month trials. Two weeks after you’ve efaxed your claims, I highly recommend calling the claims department to make sure they actually received it and check if there’s anything else they need. Otherwise, you may not find out for a long time – especially if you don’t have easy access to your mail.
Getting Reimbursed
Five months after I submitted my first claim, I received my first check from my supplemental insurance plan. Yeah, that’s a really long wait, but you know what - THEY ACTUALLY PAID OUT!!! The checks were initially mailed out to the mail service we use in Las Vegas. Trying to get them was a hassle, and not to mention pricey because the service we used charged us $5.50 + postage each time we requested a mail out. My friend was kind enough to let me use his PO Box to have the remaining checks sent to and deposited the checks for me (the checks expire after 90 days).
Regular Health Insurance
Although I was very sure my regular insurance with Health Plan of Nevada (HPN) wasn’t going to cover any part of my surgery and post-op care, I provided my insurance information to all my medical providers (except for physical therapy – it’s a lot cheaper to pay out of pocket if you’re pretty sure insurance won’t cover it).
I asked all my medical providers to submit a prior authorization to my insurance before my appointment. In my case, all the prior authorizations were approved by my insurance, but whether or not they would cover the cost of the visit was another story. Each of my medical bills were handled differently. One or two visits were approved and actually entirely covered by HPN after the medical facility submitted the claims on my behalf. Most of the other claims were denied, which I then appealed.
My medical bills came out to over $15,000. HPN was able to lower my bills by maybe $500. Out of my $6,600 deductible, only $1,946.24 of my bills were applicable. And only $2,446.72 was applied towards my $7,900 out-of-pocket. I would’ve totally been screwed if it wasn’t for accident insurance.
TIPS
Keep all your medical bills and records organized.
Take notes for EVERY phone call including time, date, names of reps, and what they said.
Have a really good tracking system for:
Which claims you’ve submitted
The date you submitted your claims
Date and name of the insurance agent you spoke to
Status and notes of the claims
When and the reimbursement amount of each check you receive
It’s worth appealing any claims that get denied by either insurance company.
Submit ALL your medical bills to the accident insurance company, even if they say your plan doesn’t cover it or only covers X-amount of visits. I’ve been told one thing, but still had bills reimbursed despite it.
If the physical therapists you choose isn’t in-network with your health insurance company, it’ll be cheaper to pay for the PT visits out of pocket without using your health insurance. Otherwise, you’ll be responsible for the remainder amount of what your insurance company won’t pay the PT, and that tends to be a lot more expensive than if you just didn’t use health insurance at all.
My accident insurance plan reimbursed me for my physical therapy visits.
Be ready to spend hours on the phone with the insurance companies about your claims.
Most importantly: Remember that you have to be an advocate for yourself because no one else is!
