6 tips to help you get the most out of your health insurance
Health insurance in the United States can be confusing. Many people don't have good insurance they can afford, and millions have no health insurance at all. There are many fundamental changes the federal government must make to make health insurance work better.
Read your plan's coverage documents every year, even if you think you know what they say
Before you can learn how to use your blueprint, you need to know what's inside.
"Many consumers don't take advantage of their health insurance benefits simply because they don't know they exist, or worse, they end up paying out of pocket for whatever costs they can afford," says Tasha Carter, Florida Consumer Insurance Attorney. She helps people understand all types of insurance, including health insurance, and her office advocates on behalf of Florida consumers when making insurance decisions.
Health insurers are required to provide a written summary of benefits and coverage in plain language. If you didn't receive it in the mail earlier this year, you can call and request it on your health insurance company's website or at the number on the back of your insurance card.
At the start of each year, take a few minutes to review your benefits summary, even if you've been on the same plan for a long time and you're pretty sure you know what's in it.
“Often, insurance companies also change the temporary benefits that normally apply when renewing a policy. So you need to make sure you review them and understand what those changes are and how they might affect you,” says Carter.
It's also worth checking your performance if your health has changed recently. Aspects of your plan that you weren't interested in before may matter now, such as B. Specialist support or prenatal services.
“If consumers could just make it a traditional practice to review their health insurance policies, it would only get easier over time,” Carter said.
Find yourself a good primary care doctor
How you use your health insurance depends on your medical condition. An annual physical exam with your GP can keep you updated on what's happening inside your body and give you an idea of what kind of health care you may need in the year ahead.
Dr. Nicole Rochester works with patients and their families to navigate the healthcare system. She says it's very important to have a doctor who really knows you, preferably for many years.
"If you don't have a GP, you go to different providers sporadically when you're sick," she says. "They don't know what's normal for you when it comes to your vitals or even your lab tests, so the only way they can react is in that moment."
A good doctor who knows your family history and your normal vital signs and symptoms. They can help you stay healthy by marking screenings for which you're eligible, catching problems before they become big problems, and referring you to a specialist if needed.
Don't have a doctor? Rochester suggests getting recommendations from friends or others you know, rather than relying on online reviews.
“There is nothing more powerful than talking to a friend, colleague, neighbor, community member and asking, 'Do you have a good doctor? Do you like your doctor? What do you like about your doctor? ?'" she said
"Just as we use our network of family, friends, co-workers, vacationers and hairdressers...we really need to use the same strong network when looking for a doctor."
take advantage of preventive care
Even if you have a basic tax-deductible plan or other "preventive" tests or treatments you need, they must be included; This means that you are not responsible for any premiums or other reimbursable expenses.
This includes controlling diabetes, cholesterol, and blood pressure. "Breast cancer screening is also usually free [and] vaccines are like flu shots," Carter says.
The American Academy of Family Physicians regularly updates this helpful cheat sheet with recommended age-based screenings, but your doctor may recommend otherwise based on your personal and family medical history or risk factors.
Strategically plan the schedule of procedures
Of course, you can't schedule an emergency appendectomy, but you can be strategic about timing your scheduled appointments and procedures.
Health insurance plans have a deductible amount that sets the payment threshold you must meet before your medical bills are fully covered by your insurance. Depending on your plan, your annual waiver could be a few hundred dollars or up to $7,000. On January 1 of each year, your exemption resets, which means you will continue to pay your medical bills until you reach this threshold.
If you have a major medical procedure that you can plan for, Rochester says there are several ways to approach planning to maximize your health coverage. "Some people will wait until they get their exemption to have major surgery," she explains. It might make sense if you don't have a lot of money saved up. If you pay your waiver with the health care you get throughout the year and then schedule the surgery after you meet with him, your insurance is more likely to pay most of the cost of the surgery and you won't have to. Paying a large bill out of pocket.
Others who get their money upfront may choose to schedule a more expensive procedure to cover their waivers earlier in the year, with the peace of mind that insurance will cover the rest of their healthcare costs this year.
Learn how to file a complaint
If you go to a doctor or clinic that doesn't bill your insurance, you may need to pay the full cost at the time of your appointment and file a claim later in order for your insurance to reimburse you for at least part of it.
When making petty cash payments, ask for an itemized receipt that you can use to file your insurance claim. Before leaving the clinic, print the information you need, such as your service history and diagnostic code.
Next, you will need an insurance claim form. To be sure, Rochester recommends calling your insurance company and requesting the correct claim form, even if you think you found the form online.
Once you have the correct claim form for your plan, fill out all the information except for the signature and date fields, and then make or scan copies. From now on, whenever you need to file a complaint, just sign, date, and mail (or scan and email) the detailed receipt from your doctor.
In some states, your insurance company must process your claim and pay you or your provider within a specified period of time, such as 30 days, after receiving your claim. You can check the website of the State Insurance Department.
Don't miss out on the perks
There's a lot of juggling to do with just getting — and solving — basic health insurance in the United States, but for all the financial and logistical hassle of navigating health insurance in this country, your plan insurance can also offer big discounts. offers.
Interested in taking Zumba lessons? Your insurance company may offer a discount if you join a local gym. In addition, B. may offer discounts on services that improve your quality of life, such as LASIK surgery or massage. You can save money on prescription drugs by visiting your insurance company's preferred pharmacy or checking your insurance company's website for different providers or facilities for the care you need.
If the thought of your health insurance makes you groan, you're not alone. But Rochester suggests putting it this way: "Your health insurance plan is a tool that allows you to improve your health, but you can only do that if you use it fully, and you can only do that if you take the time to explore and clearly understand the plan and the benefits it has." progress.”