Before you decide how you can make use of your plan, you need to understand what’s included in it.
“Many consumers fail to take advantage of the benefits that are offered by their health insurance policy simply because they don’t know they exist – or even worse, they end up paying out-of-pocket for expenses that may have been covered,” Explains Tasha Carter as an Insurance Consumer Advocate for the state of Florida. She helps people comprehend the various types of insurance available that include health insurance and her office works in the interests of Florida customers whenever insurance decisions are taken.
Insurance companies offering health insurance must required to provide a brief summary of coverage and benefits written in plain English. If you don’t receive it by mail at time of year’s beginning, access your health insurance’s website or dial the number on the reverse of your card to inquire for the document.
At the beginning of each year you should take a moment to review your summary of benefits even if you’ve been on the same plan for quite a while and are pretty certain you’re aware of what’s included.
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“Oftentimes insurance companies also make changes to benefits in terms that are usually applicable upon renewal of the policy, and so you want to make sure that you’re reviewing those and you understand what those changes are and how they may impact you,” Carter says.
It’s also worthwhile to review your benefits in case your health has changed in recent years. Certain aspects of your insurance plan which weren’t relevant to you previously could become important now, such as insurance for specialists or benefits for prenatal care.
“If consumers can simply make the review of their health insurance policy a traditional practice, it’s something that becomes easier and easier to do over time,” Carter says. Carter.
Find yourself a top primary care physician
The amount you spend on health insurance is contingent on the condition of your health. A routine checkup with your primary care physician will inform you of what’s happening in your body. It can also give you a sense of the kind of health treatment you’ll require over the next 12 months.
Dr. Nicole Rochester works with patients and their families to help navigate the system of healthcare. She believes that the importance of having a doctor that understands you – perhaps over a long period of time is crucial.
“When you don’t have a primary care doctor, you’re going sporadically to different providers when you’re sick,” she declares. “They don’t know what’s normal for you [when it comes to] your vital signs or even your laboratory studies, so all they can do is react in that moment.”
A good doctor who understands your family history as well as your typical essential indicators and symptoms. They can keep your health by identifying exams that you’re qualified for, spotting problems before they escalate into major issues and directing you to specialists if you require one.
Are you unable to find an primary care physician? Rochester suggests seeking referrals from your friends or others whom you know instead of making use of online reviews.
“There’s nothing more powerful than talking to a friend, a coworker, a neighbor, a congregation member and asking, ‘Do you have a great doctor? Do you like your doctor? What is it you like about your doctor? What is it you don’t like?'” she asks.
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“Just like we utilize our family and friends and colleague network for vacations and hair stylists…we really need to tap into that same powerful network when looking for a physician.”
Utilize preventive medicine
Even if you’re covered under an unrestricted, high-deductible policy all screenings and different “preventive” care you need must be covered which means you’re not liable for a copay or any other costs out of pocket.
This includes having a screening for cholesterol, diabetes and high blood pressure. “Typically, breast cancer screenings are also free [and] immunizations such as getting the flu shot,” Carter adds. Carter.
The American Academy of Family Physicians regularly updates its checklist that lists recommended screenings based on age. However, your doctor may recommend something else dependent on your individual health history and your family’s medical history, or the risk factors.
Set the time of procedures strategically
You can’t foresee an appendectomy in the event of an emergency, but you can plan the timing of sessions and protocols.
Health insurance plans include the the the deductible amount. This determines the amount of payments you must reach before you can be fully covered by the insurance. Based on the plan you have the annual deductible can be a few hundred bucks or up to $7,000.
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Each year, on January 1 your deductible is reset to zero. This means that you’re still paying for medical bills out-of-pocket until you reach the threshold.
If you’ve got a significant medical procedure you’d like to plan for there are a variety options for scheduling it to maximize the coverage you have for health insurance, Rochester says. “Some people will wait until they’ve met their deductible to get a big procedure,” she says. This might be a good idea when you don’t have a large amount of cash saved. If you contribute to your deductible through health services that you receive throughout the year, and then book an appointment for surgery after you’ve met your deductible most likely that your insurance will cover most of the cost, and you won’t be required to cover a large cost out of pocket.
Some people who have money in the beginning may decide to go through a more costly procedure to pay their deductible earlier in the year, while having the security of knowing that the remainder of their medical expenses for the year will be insured.
Learn how to submit an insurance claim.
If you visit a doctor or visit a facility which doesn’t invoice your insurance then you might have to pay for the entire price at the moment of your appointment. You can also submit a claim following the appointment to ensure that insurance will reimburse you for a portion of the cost.
If you’re paying out of pocket make sure you have an itemized receipt that you can use to submit an insurance request. When you leave the doctor’s clinic request for them to print a receipt for you with the data you require, including your date of visit, as well as your diagnosis number.
In the meantime, you’ll need an insurance claim form. Rochester suggests contact your insurance provider to inquire about the proper claim form, even if you think that you’ve discovered it online, to make certain.
When you have the right claim form for your insurance plan, you need to fill in every field with the exception ofthe dates and signature fields. Once you have completed it, print it or scan it. Once you have completed it, if you require you to submit a claim all you have to do is sign the form and date it, then stick on the back of your mailer (or scan it and send it to the insurance company) along with the receipt by your physician.
In some states, when the insurer receives your claim, they must to review it – and then pay the provider or you – within a specified time frame that is usually 30 days. Check out the state’s insurance department’s website for more information on the State’s “prompt pay” laws.
Don’t be left out of the benefits
It is a challenge to manage many things to obtain the basics of insurance coverage for health across the U.S. However, despite the administrative and financial stress which come with the process of navigating the world of health insurance the insurance you choose to purchase may have some great benefits.
Want to take zumba classes? Your insurance provider may offer discounts when you purchase a gym membership in your area. They may also offer discounts on certain services that will improve the quality of your life for example, LASIK procedures or massages. It is possible to reduce the cost of prescription medications through your preferred insurance pharmacy, or by looking at the website of your insurance company to find different facilities or providers for the services you require.
If the thought of the health insurance you have makes you grumble, you’re certainly probably not alone. However, Rochester suggests using the following approach: “Your health insurance plan is a tool for you to maximize your health, but you can only do that if you utilize it fully, and you can only do that if you take the time to explore and to have a clear understanding of your plan and the benefits that it offers.”
The podcast portion of this story was produced by Andee Tagle.
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