How to Get the Most Out of Your Health Insurance Benefits

healthcare benefitsHealth care is a really big issue in our country. And, it's no wonder.  Costs seem to be going up and up and folks are getting squeezed financially to keep up. Today, it's vital you are getting the most out of your health insurance coverage so that you can limit your out-of-pocket expenses.

I'm fortunate enough that my employer has good health insurance benefits. Many do not have this luxury. And, it seems that more and more businesses are moving towards “consumer-driven health plans” with higher deductibles to help curb the rising costs of healthcare.

I checked with a family member who works in the health insurance field to see about what folks can do to make sure they aren't paying too much for doctor visits and are able to get the most out of their coverage.

Here were some of their suggestions:

  • Understand what is the best coverage for you. Each employer has their own unique coverage plan that has been selected by its leadership. Some offer different plans to choose from – while others only provide one option. If you have a choice – seek to understand the best option for your individual situation. If you are single, healthy and have little family history of recurring health issues – you may be looking at a high-deductible plan. If you are a family man with 4 children – you are likely going to be looking at a full-coverage plan – which will have more depth to it.
  • Know your benefits. This requires some work on your part – but it can save a lot of money. If you know exactly what is covered in your plan, the chances of a benefit not getting covered becomes less and less. While you may be provided with a one to two page summary of your benefits when you enroll in your employer's health plan option, you are also entitled to see something that is most of the time referred to as a “certificate of benefits”. This is a more detailed description of covered (or not covered) services and equipment and you can obtain this from your human resources department (if it hasn't been supplied already).
  • Stay in the network. Insurance companies make contractual agreements with selected providers to improve care and get better rates. These providers are then in that insurers “network”. You'll want to make sure you stay within this group outlined in your plan to pay the least out-of-pocket.
  • Don't always trust the insurance company to give you the right coverage information over-the-phone or online. I know this from experience in our own family. Faced with a high cost medical expense – we were initially told by the insurer that a procedure would not be covered. After doing some of our own investigation in the certificate of benefits, we uncovered that – in fact – the procedure was covered. This is why its vital you know your benefits.
  • Ask for the diagnosis code and CPT (or Current Procedural Terminology) codes. After your visit to the doctor, be sure to get a proper diagnostic code and ask for the CPT code they will be sending to the insurance company. If you provide your health insurance company with this information, they'll be better equipped to tell you if  future treatments are covered.
  • Document, document. It's possible that you may be told by your health plan that a certain procedure is covered, only to find out after that you've been stuck with the bill. This is why it's important to document your conversations with your health care  provider and insurance company (name of person you spoke with, date, time, etc) so that you'll be able to counter any non-payment. It's possible a mistake was made and asking the provider to send the claim in again or filing an appeal can also be beneficial.
  • Negotiate. Given the present financial climate, many providers are willing to negotiate on certain out-of-pocket expenses. It never hurts to ask for a reduced rate.

We hope this helps. Healthcare can be a confusing and complicated process which can be made worse when you are undergoing a health crisis. Make sure you are prepared well in advance.

Are there other ways you are getting the most out of your coverage?

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  1. I think our shift to consumer-driven care is the right way to go. It decreases the burden on employers. It encourages people to use the health system only when they have to, which increases efficiency. And it encourages people to put their well-being into their own hands, to the extent possible. Also, with a health savings account you can roll over the amount you don’t use from year to year. In this scenario you’re effectively acting as your own insurer, subsidizing years with high healthcare expenses with those of low expenses.

    • Yeah – good thoughts Ryan. It’s great for folks who are younger, in good health, etc – but would really stink for those who can’t help their health situation and are always needing care, etc.

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