Health Insurance Tips Procedure – How to maximize your health insurance coverage: 6 tips you need to know : Life Kit Using your health insurance doesn’t have to be on an “emergency” basis. Learn how to get the most out of your coverage by taking advantage of preventative care, strategic timing procedures, and exercise class coverage.
Health insurance in the US can be confusing. Many people do not have access to good coverage that they can afford, and millions of people do not have health insurance at all. There are many big changes the federal government needs to make to make health insurance work better.
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In the meantime, if you’re lucky enough to have health insurance with the system in place, you can use your insurance strategically to prepare for better health and lower out-of-pocket costs.
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“Many consumers fail to take advantage of the benefits offered by their health insurance policy simply because they don’t know they exist—or worse, end up paying out-of-pocket costs that may have been covered,” explains Tasha Carter, an insurance consumer advocate at Florida State. She helps people understand all types of insurance – including health insurance – and her office advocates on behalf of Florida consumers whenever insurance decisions are made.
Health insurance companies are required to provide a summary of benefits and coverage written in plain language. If you don’t get it in the mail at the beginning of the year, you can log in to your health insurance website or call the number on the back of your insurance card and ask for it.
At the beginning of each year, take a few minutes to review your Summary of Benefits, even if you’ve had the same plan for a long time and are pretty sure you know what’s in it.
“Often insurance companies also make changes to the benefits and terms that are usually applicable after the policy is renewed, so you want to make sure you review them and understand what those changes are and how they may affect you,” Carter says.
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It’s also worth checking your benefits if your health has changed recently. Aspects of your plan that didn’t matter to you before may now matter, such as specialist coverage or prenatal benefits.
“If consumers can simply make reviewing their health insurance policy a traditional practice, that’s something that gets easier and easier to do over time,” Carter says.
How much you use health insurance depends on what happens to your health. An annual checkup with your primary care doctor can inform you about what’s going on in your body and give you an idea of what kind of health care you might need in the coming year.
Dr. Nicole Rochester works with patients and their families to manage the healthcare system. She says it’s really important to have a doctor who really knows you – ideally over many years.
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“When you don’t have a primary care doctor, you go to different doctors every now and then when you’re sick,” she says. “They don’t know what’s normal for you [when it comes to] your vital signs or even lab studies, so all they can do is react in that moment.”
A good doctor who knows your family history and your usual vital signs and symptoms. They can help you stay healthy by flagging exams you’re eligible for, spotting problems before they become major concerns, and referring you to a specialist if you need one.
Don’t have a primary care doctor? Rochester suggests getting referrals from friends or other people you know, rather than relying on online reviews.
“There is nothing more powerful than talking to a friend, a colleague, a neighbor, a congregation member and asking, ‘Do you have a great doctor? Do you like your doctor? What do you like about your doctor? What is it about you that you don’t like?'” she says.
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“Just like we use our network of family and friends and colleagues for vacations and hairdressers… we really need to use that same powerful network when we’re looking for a doctor.”
Even if you have a simple, high-deductible plan, any checkups or other “preventative” care you need should be included — meaning you’re not responsible for copays or other out-of-pocket costs.
This includes testing for diabetes, cholesterol and blood pressure. “It’s common for breast cancer screenings to be free [and] immunizations like the flu shot,” says Carter.
The American Academy of Family Physicians periodically updates the handy cheat sheet with recommended screenings by age, although your doctor may recommend something different depending on your personal and family medical history or risk factors.
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Obviously you can’t plan for an emergency appendectomy, but you can be strategic about the timing of scheduled appointments and procedures.
Health insurance plans come with a deductible amount, which defines a threshold of payments you must reach before your health insurance will fully cover your insurance. Depending on your plan, your annual deductible can be a few hundred dollars or as high as $7,000.
On January 1st of each year, your deductible resets to zero, meaning you go back to paying for medical care out of pocket until you reach that threshold.
If you have a major medical procedure to plan, there are several ways to approach scheduling it so that you maximize your health care coverage, Rochester says. “Some people will wait until they meet their deductible to get a major procedure,” she explains. This might make sense if you don’t have a lot of money saved up. If you pay the deductible with the health services you receive during the year and then schedule surgery after you meet it, your insurance is more likely to pay most of the cost of the surgery and you won’t have a large out-of-pocket bill.
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Others who have money up front might decide to schedule a more expensive procedure to pay the deductible early in the year, with the peace of mind that the rest of their medical expenses that year will be covered by insurance.
If you see a doctor or go to a clinic that doesn’t charge your insurance, you may have to pay the full cost at the time of your appointment and file a claim afterward to get at least part of it back from your insurance.
When paying out of pocket, ask for an itemized bill that you can use to file an insurance claim. Before you leave the office, ask them to print one for you with the necessary information, such as the date of service and diagnostic code.
You will then need an insurance claims form. Rochester suggests calling your insurance company to ask for the right claim form—even if you think you found it online—just to be sure.
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Signature and date fields, then copy or scan them. After that, whenever you need to make a claim, all you have to do is sign it, hand it in, and stick it in the mail (or scan and email it) with your detailed bill from your doctor.
In some states, after your insurer receives your claim, it must process it—and pay you or your provider—within a certain time frame, such as 30 days. You can find information about your state’s prompt pay laws on your state insurance department’s website.
We have to juggle so much just to get—and understand—basic health care in the US. But despite all the financial and logistical headaches that come with navigating health insurance in this country, your insurance plan can have some nice perks, too.
Would you like to take a Zumba class? Your insurance company may offer a discount if you get a membership at a local gym. He might also offer discounts on services that improve your quality of life, such as LASIK surgery or massages. You may be able to save money on prescription drugs by using your insurer’s preferred pharmacy or shopping on your insurer’s website for the different providers or care facilities you need.
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If the thought of health insurance makes you groan, you’re not alone. But Rochester suggests framing it this way: “Your health insurance plan is a tool to increase your health, but you can only do that if you take full advantage of it, and you can only do that if you take the time to research and have a clear understanding of your plan and the benefits it offers.”
We would love to hear from you. If you have a good life hack, leave us a voicemail at 202-216-9823 or email us at [email protected] Your tip may appear in an upcoming episode. Shopping for a family or an individual can be daunting. From where to get coverage to what you need to provide, you probably have a lot of questions.
Whether you need to apply for health insurance for the first time or need to change your insurance plan, understanding health
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