How To Make Sense of Your Health Insurance

 In Affordable Care Act, Health Care, Health Insurance

Mistakes can be expensive: Understanding Your Health Insurance

Health insurance should be part of any good overall financial plan, but have you ever stopped to think about how much you really understand about your health insurance? You keep paying the premiums but are you getting your money’s worth? Are you sure your insurance company is not trying to avoid paying your benefits?

If you don’t have a good understanding of your healthcare coverage or insurance, there may be a big downside. A lack of complete understanding can lead to:

[arrow_list] [list_item]Getting needlessly charged by your health insurance. In every case, procedures have to be followed. In some cases visits to certain specialists require a referral before your visit. Your insurance provider can refuse to pay if you did not get a referral before seeing a particular medical service provider.[/list_item] [list_item]Having to pay more for your health plan. If you did not check to make sure that your doctor is covered in your health plan network, coverage might be significantly less than you anticipate. If you make this mistake, you might have to pay up to 80 percent of the charges out of your own pocket.[/list_item] [list_item]Losing Health benefits. Your health insurance company may be making some serious changes to your plan due to changes in the Affordable Care Act (Obama Care).[/list_item] [list_item]Forfeiting appeals. Yes, you can appeal denial of a coverage. However, if you are not familiar with the internal procedures that must be followed to succeed in an appeal, or if you miss the deadline for filing your appeal, you stand to lose any chance at it. This penalty doesn’t just happen with for coverage denials, it also applies when your health insurance refuses to authorize treatment by a specialist.[/list_item] [/arrow_list]

In the end you’re out money, and the rub is that you will have to keep paying your health insurance provider for their services.

So what do you do? Here are some helpful suggestions to make sure you are getting the most out of your health insurance.

Getting the Most out of your Health Insurance

[arrow_list] [list_item]Know your plan’s network and stay in it. You might need a certain specialist for some treatments, but not all doctors are part of every health insurance networks. Find out who is included in yours.[/list_item] [list_item]Be familiar with your coverage. Know your deductibles, co-payments and co-insurance. Co-payments are usually between $10 to $50 per office visit, depending on the specialist. However, up front payments for admissions, surgeries or other procedures are often more expensive.[/list_item] [callout font_size=”16px” style=”skyblue”]Deductibles are usually not paid by the health insurance company. A deductible is a set amount you pay before your insurance begins to pay. That makes it important for you to keep track of your out of pocket expenses.[/callout] [list_item]Be familiar with procedure. Know what you have to do to appeal a coverage denial or refusal to authorize treatment. Most importantly, find out how much time you have to file an appeal.[/list_item] [list_item]Make use of the online tools on your insurance website. Many sites provide tools. You can use these tools to check your deductibles and claims and even to look for doctors or specialists who are part of your health insurance network.[/list_item] [/arrow_list]

As a personal health insurance advocate Amazing Healthcare Consultants helps individuals and families make sense of their health insurance plans and bills.

Carol Gordon DeVore, M.D.

Carol Gordon DeVore, M.D.

Founder & Patient Advocate at Amazing Healthcare Consultants
Twenty nine years as a physician have brought me great personal and professional satisfaction, but a new passion has driven me to change directions within the healthcare system. I'm acutely aware of the confusion and frustration that patients face as they navigate the healthcare "maze" and look forward to helping patients in many new ways as a private healthcare advocate.
Carol Gordon DeVore, M.D.

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