Ann
The Good, The Bad, and The Ugly...
This is decent carrier if you need to visit your primary care physician from time-to-time for normal stuff - and don't want to deal with a high deductible. However, if you have a standard hospital procedure, like a colonoscopy, you may be surprised to discover very little is covered by Sidecar. I shudder to think how stressful working with Sidecar would have been if I had a serious health issue with a broad spectrum of providers to help me. Based on my disappointment with this latest claim, I would have given Sidecar only one star, but they handled simpler claims with fairness, and some members of their customer service team tried to help me get documentation from three different service providers. I think they want to do good. The unfortunate truth is that this insurance isn't built for the realities of today's medical system. In order to get proper medical codes for Sidecar processing, you would need to have your bills processed like a standard insurance claim - but that can't happen because Sidecar isn't recognized by the medical profession. So, you end up stuck between a rock and a hard place. For peace of mind, I will be switching to Obamacare next year. Updated on 1/12/24: I made the switch to Obamacare starting in February, which would have covered almost all the recent colonoscopy costs as preventative. Don't get me wrong - the people from Sidecar want to help, but the basic concept falls apart when big medical networks are involved, and the hospital assumes you're a self paying customer. One of Sidecar's customer service reps has already spent a lot of time trying to call for info - but the hospital sent a bill with internal rather than standard medical codes. The descriptions are pretty clear, though. I will definitely update my rating if these claims can be resolved successfully with Sidecar. I hope their management will look at my experience, and other similar ones on Trust Pilot related to documentation, and come up with a set of expectations and policies for the future. This could be good insurance if they could work out this kink! In the meantime, it's causing me a lot of unnecessary time and stress to discover I'm currently on the hook for $5K in medical expenses - and would have had $4K covered automatically if I had enrolled in Obamacare! Updated on 2/7/24 - I'm happy to say that Sidecar did work with the documentation the hospital provided. We were never able to get the standard medical codes hospital, but it looks like Sidecar assigned codes after reviewing all the documentation I submitted. My final reimbursement was almost $1500 on a $5300 in colonoscopy charges. Not very good but better than less than $250 after my first document submission. If I had gone through an Obamacare insurance provider, I probably wouldn't have paid more than $1K out of pocket - vs. $3.5K through Sidecar. This is another area of breakdown in the Sidecar system. Some health care providers actually charge self-paying patients more - not less! To my surprise, none of my medical providers were willing to negotiate a cash price after the bill had been generated too. I would have given Sidecar 4 stars before this experience with a standard colonoscopy. By the time I finish my policy after 22 months, I will have received about $4.5K in paid benefits for about $16K in premiums paid. They do pay on claims (sometimes fairly, sometimes miserly) - but I would not to want to be in a compromised health condition, struggle to get documentation, and deal with lots of uncertainty about how much can really be reimbursed. Obamacare will be far less stressful - which is important if you need health insurance that reduces financial risk. Reply to Sidecar Message - I think your response highlights two weaknesses with your offering: 1.) I wish I would have been told from the git-go that you could find a health care provider at a better cost so I didn't have to pay an extra $3.5K out of pocket. Instead, your marketing emphasizes i can select my own health care provider; 2.) My main reason for leaving Sidecar is that I wanted insurance that would not be a wild ride if I had an emergency or a severe health challenge. Sometimes, it's not possible to shop for a treatment. The $2M benefit policy was misleading to say the least I was lucky the financial damage was limited to $3.5K. It would have been a much worse situation if I had a health challenge and got billed $50K - and then went through multiple frustrating rounds of gathering documentation - and still owed $35K. Unnecessary risk and stress is UGLY.
Response from Sidecar HealthDec 29, 2023
Hi Ann, thank you for taking the time to write this review. If you need any resources on finding cost-effective care, our Member Care team is always standing by to help point you in the right direction. Many of our members get account credit for their colonoscopies, as the amount they pay for their care is lower than our Benefit Amount. Some procedures like a colonoscopy can involve many different types of fees, like a facility fee, provider fee, and anesthesiologist fee. Sidecar Health has Benefit Amounts for each of these that are set to the average in the market, so that our members are always able to get colonoscopies at or below the Benefit Amount. This review is for the Sidecar Health Access plan. Sidecar Health also offers employer plans, which provide more robust coverage and additional major medical protections.