FREQUENTLY ASKED QUESTIONS
How can we help you?
BCBS is a traditional policy: Deductible, Copay, Out-of-pocket max. Puresurance offers a high-end defined benefit plan. In other words, it pays a specific benefit for services rendered. Any excess benefit is reimbursed to you, any shortfall might be due to your provider. The only exception is the catastrophic components of our plan, which function similar to a BCBS, UHC, Cigna, or Aetna plan. Our benefits are in line with the average costs of provider contracted (or insurance discounted) rates.
First of all, there’s no such thing as a $1,000,000 claim – it’s a collusive tactic between hospitals and insurance companies to scare you into believing you need major medical coverage. The odds of a $500,000 claim are close to 1 in 87,000. One of the most expensive procedures, a heart transplant, has a fair price in Dallas (per Healthcare Bluebook) of $145,699 and a range of $116,561- $364,248 (including hospital stay). The catastrophic component of Puresurance’s policy, coupled with the base medical plan (they work in concert and both pay benefits) ensures that you and your assets are well-protected, should the worst occur.
Puresurance’s policies are medically underwritten, in contrast to Major Medical Plans, which are Guaranteed Issue. Medical underwriting ensures that all prospective insureds are relatively healthy and free from serious chronic health issues such as Cancer, Diabetes, and Heart Disease. The result is, you’re in a pool with other healthy people and not subsidizing the costs of those with chronic issues like you are on a Major Medical Plan. The result is lower premiums and annual increases of about 1.5% instead of the egregious annual increases plaguing ACA/Obamacare Plans. That said, should you contract any of the diseases mentioned above (or others), you’d be well-protected on a Puresurance Policy, guaranteed renewable to age 65.
As previously mentioned, one of the reasons that Puresurance’s policies are so affordable is that they’re medically underwritten, so any proposed insured would need to be relatively healthy to qualify. Also, only medically necessary procedures are covered – that is, we would not pay benefits for a normal, healthy pregnancy, but we would, should an emergency C-Section need to be done. Additionally, Puresurance does not pay for medical equipment (eg CPAP machines, diabetes pumps, etc.). And lastly, our prescription benefits on our top-level plan is $30/generic, $60/brand name, so if insulin, Humira, or any other expensive medication is needed, we might not be a good option (unless the medication can be gotten directly from the manufacturer at a steep discount).
While our clients enjoy the benefit of participation in the entire PHCS provider network (900,000 strong nationwide), you’re free to see any provider you wish (really), and you’re not penalized for doing so.
Once an ER knows you have insurance, prices can be marked up as much as 1,100%! Always go in as a self-pay patient, and you’ll get the true (fair) price of whatever procedures they administer. That said, the ER should ALWAYS be the last resort. The first should be Teladoc (doctor-on-demand), then Urgent Care, and finally the ER. Puresurance’s robust hospitalization benefits kick in once you’re admitted overnight.
Puresurance pays the same benefit whether you stay in-network or go outside the network. The only difference is, an in-network visit has the convenience factor of simply showing an insurance card, and the provider/urgent care/hospital filing the claim for you. If you were to go out of network, self-pay at time of visit (you’d get the discounted ‘cash price’), then submit yourself for full reimbursement. The end result would be very similar: the discounted insurance rate vs the cash price are pretty close (from a benefits standpoint, you’d most likely do better paying the discounted cash price everywhere, and self-submitting claims for the full benefit).