Do you know how to get the most out of your health insurance plan?

July 17, 2018 in Health Risk Management  •  By Miles Varn
health insurance tips

Understanding how your health insurance plan works and what benefits and additional services are included as part of the plan can help you get the care you need and save money. The first step to getting the most out of your health insurance is to choose the plan that fits your needs best. Picking a plan based only on the premium you have to pay can be a mistake. Often, lower premium plans have significantly higher deductibles. If you’re healthy and only use your preventive care benefits like annual check-ups and covered screening tests like mammograms, these plans may be the right choice. However, if you’re living with a chronic health condition, are diagnosed with a serious illness or seriously injured, or plan to have a baby this year, a less expensive, high deductible plan could leave you paying thousands of dollars out of pocket before your plan starts to pay for your care.

These tips can also help you get the most from your health insurance plan:

  • Stay within your plan’s provider network: Before choosing a primary care doctor or seeing a specialist, find out whether the physician is a member of your health plan’s provider network. These physicians have contracted with the insurer to provide care to members for a lower cost. Before you meet your deductible, you’ll be responsible for paying that cost and if you use a provider outside the network the amount you pay out of pocket could be significantly more than if you used an in-network provider. Remember to also check to be sure labs, imaging providers, and urgent care centers are in-network.
  • Check to see whether you need preauthorization or precertification: Some plans require that you get special approval for some types of care. You can find out what services need to be preauthorized or precertified by checking your plan documents or calling your insurer. Also ask who needs to request the approval. Some plans require you to start the process, while others require the physician or facility providing the service to request approval.
  • Schedule non-urgent appointments that aren’t covered under preventive care benefits after you meet your deductible: Once you meet your annual deductible, your out-of-pocket costs for covered services go down because the plan pays the provider and you’re only responsible for any copays or coinsurance. That makes it a good time to see your doctor for services that don’t fall under covered preventive care services like an annual physical.
  • Make sure you’re not paying extra because of billing errors: Mistakes on medical bills are more common than you may think. Take the time to carefully review all bills and the explanation of benefits forms you receive from your insurer. Checking your bills is especially important when you receive care in the hospital, see a specialist, or receive care from a healthcare provider outside your insurance network.
  • Take advantage of programs and discounts offered through your insurance: Many insurance plans include discounted or free wellness benefits like smoking cessation, weight loss programs, gym memberships, and more. Check your insurer’s website to see what benefits and discounts are available with your plan. Some employers and insurance plans also offer programs to help if you need a second opinion or case management if you’re diagnosed with a serious illness or chronic health problem.
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