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10 Things You Need to Know About Your Health Insurance

Author: Christina Cross    Posted: June 23, 2015

1.  Don’t ask your Doctor how this prescription or that procedure is covered; he specializes in medicine not health insurance, no matter what they tell you!

Recently, I tested my theory during a preventive checkup.  Doctor stated that all of my blood work would be covered at 100%, based on health care reform.  Being an insurance advocate I knew that was not the case. I bet her $10 bucks I would have a portion to pay, regardless of Obamacare.  I was right; I did not get my $10 bucks.  As a user, you should have a copy of the list of preventive services covered by your plan and provide it to your doctor (typically this comes from your open enrollment or most carriers offer on-line access); every carrier has one.  Then, if you decide the benefit of the test outweighs the cost, you have made an educated decision and know what to expect.

2.  When your doctor’s office asks you to sign a document prior to a procedure, read the document in detail, prior to signing.  It could be a document stating the stats of this particular procedure or better yet it could be you signing your house over for any costs that the insurance won’t cover.

We have seen documents that inform patients that they will receive services from out of network providers or providers that aren’t covered by their insurance at all. This can be a very costly mistake spelled out in the fine print. If at all possible, work with your doctors and your insurance advocates to coordinate the best care and coverage available.

3.  When you get a bill, don’t put it in a drawer and assume it’s covered! They will find you and you will pay – regardless!

Time and time again I have fixed back-dated bills that were put in drawers thinking they were paid by the insurance company.  It is much easier to fix them when they are new bills.  I have also seen bills at collections, lawyers and garnishments, there is much less we can do the more issue escalates. Your carrier sends you an Explanation of Benefits.  If you see “Patient’s Responsibility” $0.00 – great.  If you see, any other amount, you need to be looking into this further!

4.  If you are having a surgery, be sure all of the preauthorization’s are done and all doctors are in the right network and covered with the minimum out of pocket possible for you.

Your doctor’s office typically will do this for you and they can be very good at it.  Yet my theory is if I am paying a portion of this surgery, I want to know all the details, 100% upfront. It’s never a bad idea to double check with your insurance advocate that the preauthorization was done and approved. Lowering stress around major health events is a part of getting well again.

5.  Know, ahead of time, where the closest urgent care facilities are in your area.  Find out their hours of operation and save that in your cell phone. This will save you tons of time and money!

The cost of a basic emergency visit is $1000 and quickly escalates higher vs. the cost of Urgent Care starting at about $200.  There are emergencies, when you are facing permanent injury or life threatening circumstances, and the emergency room is definitely the right place to go for emergencies. If your need for care is urgent, you can save a lot of money by going to urgent care. Not only that, if you go to the emergency room for an issue that can be taken care of at an urgent care clinic, they will continue to triage people who have emergencies in front of you… you’ll be there all day.

6.  Look at the back of your Health Insurance ID card, there is a phone number for a Nurse Help-line, open 24 hours.  This number is great for parents with kids! Most Nurse Help-lines can access your record to provide the best and most informative information for you.

As a parent of grown children, I’ve used this line a few times when my kids were young and found it quite helpful.  As parents we are just so worried regardless of what the cost is.  Being informed and prepared prior to the event is vital!  The nurse line can even tell you whether you should take your family member to the emergency room or if urgent care is a better choice.

7.  When you call a new doctor do not ask if they are with your insurance carrier.  Every carrier has multiple networks and the majority of doctors’ offices will bill the insurance carrier, which does not mean they are contracted and in the right network on the right program with the right carrier. This can be tricky. It is always best to work with your insurance advocate or ensure you know exactly how to look up your network on the insurance carrier’s website.

8. If your employer offers two options don’t assume the copay is best.

Explore high deductible plans. Do all of the math. If you pay less in premium, you pay less in taxes, and your employer contributes to the deductible, the high deductible plan can easily outperform more traditional plans. This analysis can take a professional, but it can also save you thousands a year or help you build up a nest egg for health expenses later in life.

9.  There are lots of options for prescription medication. Talk to your doctor about options.

We see provider prescribe medications that can cost $500 or more per month. After a few minutes of research, we often find that there are alternative medications that cost less than $50 a month. This isn’t always the case, but a little research goes a long way. Of course, insurance advocates aren’t prescription experts and can’t prescribe medications, but they can provide you the information you need to have a more informed conversation with your doctor.

10.  Last but not least, make sure that you give your current insurance ID card to every provider and/or pharmacy and the facility.  They may not know you changed jobs and carriers have a limit of time for billing, it’s all in the contract. Just make sure they’re always billing the right insurance carrier to save yourself a lot of headaches and maybe some money too. It never hurts to double check.

These are a few simple items that will help you navigate the insurance world a bit easier.  Call us with any questions!  If we are not your advocate, hire us or introduce us to your Human Resources Department!  We are the expert’s and we want to help!

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