Southeast Insurance Solutions, Inc.
Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205
Phone: 704-560-8972
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North Carolina Health Insurance

When one is shopping for North Carolina health insurance the question always seems to come up as to what are the best ways to compare all the different plans and carriers. The four common comparisons you should definitely look at when comparing plans and carriers are the following:
1.      Are you doctors in the network and how Strong is the network?
2.      What does the copay cover?
3.      How are visits to the Urgent Care and Emergency Room covered?
4.      How do premiums compare to like plans?
Let’s take a look at each of these categories:
Most North Carolina health insurance companies for individual plans offer a PPO network. A network is a series of physicians, hospitals, or any other facility that has set a pre-negotiated fee for health care services for its members. However, not all are created equal as some networks are much stronger than others which means that you are likely to get better discounts for services. If you’re comparing a network that has a 10% market share versus a network that has a 50% market share then it is likely that the one with 50% market share will have better service discounts because they are bringing more patients to the providers.
Regardless of the market share, it is very important to make sure that your doctor participates in the network of the plan that you are looking at. By visiting an out of network provider you will likely have to pay most, if not all, of the costs. In addition, most health plans deductibles are increased for out of network doctors. You can save yourself money by making sure that your health providers participate in the carrier you are considering for your North Carolina health insurance.
One of the more popular North Carolina health insurance plans is the traditional copay plan. Most people when looking at the plans think that because they have a copay they will only pay that set amount for a routine doctor visit. This is not true as often times the copay only covers the doctor’s consultation. 
What happens if you needed lab work or x-rays that is performed in the doctor’s office? Some carriers may cover this with the copay, some may pay the first $200, and others will only pay once the annual deductible is met. Therefore it is very important to understand this so that you won’t be confused and upset when you get another bill in the mail once you visit the doctor.
Urgent Care and Emergency Room
Something else that is often overlooked in my opinion is how the plan will cover a visit to the Urgent Care or Emergency Room? With most carriers this will be covered under the deductible and coinsurance part of the health plan. Some carriers even add an additional $100 to the deductible to visit the ER. This is sort of like a penalty for going to the ER. Some carriers may truly offer a copay that will cover the visit; however the copay for an ER visit is usually waved if you are admitted to the hospital. These two types of visits aren’t usually cheap so it is very important to know what your plan will and will not cover when it comes to these services.
Premium Comparison
The final thing to take into consideration when shopping for North Carolina health insurance plans is how the premiums compare for like deductibles, out of pocket exposure as well as the points referenced above. The annual deductible will make the largest impact on your monthly premium. The other factor is the amount of coinsurance you are responsible for once the deductible is met. Typically, the higher the deductible and/or coinsurance translate into a lower monthly premium. Comparing a $1000 deductible that has an 80/20 coinsurance maximum of $5000 is not the same as a $1000 deductible with an 80/20 coinsurance maximum of $2000. You must compare apples to apples and also factor in the other points referenced in this article.
These are just a few things to consider and can be time consuming, overwhelming and frustrating for the average consumer. Your best choice is to use a North Carolina health insurance broker that can handle this for you. It costs you nothing and will save you the headaches.


Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205