Health Insurance - Fabian Can Help

The Truth On Health Insurance

The Truth On Health Insurance 

Unfortunately, getting sick or injured is inevitable. However, with the help of health insurance, you can help defray unexpected medical expenses and ensure protection for yourself and your loved ones. Medical-related expenses can, and will, rack up some pretty hefty bills. For example, one trip to the emergency room can cost you thousands of dollars and leave you financially set back for years. One thing is for certain in this unpredictable world: staying prepared for accidents and illness is imperative.

What Exactly Does Health Insurance Cover?

What some people might not realize is the cost of care does not stop after you leave health care facilities. Luckily neither does health insurance. Coverage extends to basic needs like preventative services (vaccines, screenings, etc.), prescriptions and lab tests as well. These are all elements of health care that can end up costing a pretty penny on their own, especially for single people and those who are single parents. 

Furthermore, services like mental health and substance use disorder services are covered by different health insurance plans. Counseling, psychotherapy and behavioral health treatments all fall under the umbrella of mental health and substance use disorder services and can be covered by your health insurance provider. 

What about your little ones? Insurance offers extended coverage to your family members, children included. Care for new and expecting parents is covered both before and after children are born. It is also important to note that insurance can help offset the costs of other pediatric (and general) needs. Speech-language pathology and occupational therapy are among the most common therapy needs for children all of which are covered under most plans.

    Words to Know

    For people who are new to the world of insurance, technical jargon can lead to confusion and frustration when trying to select the best plan for their lives. This is especially true for young adults who are trying to navigate the world on their own. Words like copayment, deductible and health care savings account can throw people for a loop who are just getting started. Below, we have listed a few words to know as you begin your journey in the health insurance world:

    • Copayment (often referred to as copay) – a fixed amount you pay for a covered health care service when received (ex. $25 per doctor’s visit).
    • Deductible – the amount you could owe before health insurance kicks in.
    • Formulary – a list of the names of prescription drugs your plan covers. 
    • Network – the health care places and providers your insurer uses to provide you with your care. 
    • Premium – the cost that must be paid for your insurance; this is usually paid monthly, quarterly, or yearly by your and/or your employer. 

    For a full list of medical insurance terms visit here.

    Protection You Choose

    Independent healthcare insurance is coverage that is purchased on your own. Obviously, this differs from government or employer-sponsored plans in the sense that you are in control of what and how much coverage you receive. In Texas, more than five million people go uninsured every year; most of whom are probably unsure they can even get insurance without having to go through their employer. 


    Private health insurance typically gives purchasers a wider range of options than government-sponsored plans. This means purchasers can tailor their insurance plans to their needs. Plus, the private route will typically lead to shorter wait times and more individualized care if buyers choose to get coverage from local organizations.

    Rest At Ease

    The peace of mind that comes with having health insurance is unmatched. Now that you have some insight into the insurance world, you can feel better about selecting the health care options that fit your lifestyle the best. 

    When you purchase health insurance through Fabian Ramirez Insurance Agency, LLC you can rest assured and be confident in the coverage you choose. Fabian and his team of insurance experts are ready to help you gain quality coverage and promise to be there for you every step of the way.


    What’s an EOB?

    What’s an EOB?

    You have insurance, had a doctor’s visit, received an EOB, now what?

    Knowing how to read your EOB or Explanation of Benefits, is helpful to understanding your medical coverage and may keep your gray hairs at bay. Essentially your EOB is a statement from your health insurance plan which breaks down in complete description the costs they will cover for care and or products you’ve received. This explanation is created and delivered once your provider submits a claim regarding the services you’ve received.

    Your EOB Is NOT a Bill

    There’s no need to panic! Your insurance provider sends you an EOB to help make clear:

    • Cost of care you received
    • Amount of money you saved by visiting an in-work provider
    • Out-of-pocket medical expenses you will be responsible for

    How to Read Your EOB

    Please note, EOBs are not bills. They are simply a recorded statement of the medical services you’ve received and details on how your provider plans to share costs. You do not use this to pay an outstanding bill. Your bill can be broken down into a summarization of:

    • Your details and personal information
    • The medical services received and by who
    • Amount billed: The cost of those services
    • Discounts: Money you saved by accessing care from in-network providers
    • Amount covered and paid by your insurance
    • Amount not covered: What costs your health plan didn’t cover
    • Amount that was paid by HRA (if applicable)
    • The outstanding amount you are responsible for paying

    Following this information is usually information regarding instructions on how to make an appeal, and then finally, there are more in-depth details about your total cost of care received.

    The Purpose of an EOB

    When you receive health care, your insurance provider will send you an EOB with the previously stated information. After this is received, you may receive a separate bill for the actual amount you owe. Information on this separate piece of paper will let you know where you can send your payment. Essentially EOBs are helpful because they provide you the value of your health insurance plan and can help you to gauge how much money you potentially have left in accounts related to your health insurance plan. These are also helpful for those who are wondering how close they are to meeting their deductible. That’s all the better because once your deductible is met, your provider will begin to help you pay for services received!

    If you need help understanding this information or feel like you’re in need of a different type of coverage, contact me today at 361-652-3005 and we can get started on providing you with the care and coverage you actually need.