Get the Most from Your Health Insurance Dollar
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Get the Most from Your Health Insurance Dollar

As health care costs continue to climb, many families are struggling to cover bills because their health insurance just doesn't cover as much as it used to.

A recent survey by the Kaiser Family Foundation found that two-thirds of Americans with health insurance have seen their premiums rise in the last few years, while approximately half have seen both co-pays for office visits and insurance deductibles rise. You may have also seen news reports touting "consumer directed" health care and health savings accounts as a way to cut medical costs, which do so by making consumers responsible for paying more up front.

To make the most of whatever kind of health care coverage you have, take the time to learn more about what your plan covers and how it works. Here are some suggestions to help you better understand your health care coverage:

  • Read your benefits booklet or member handbook. If you have health coverage from your employer, you should have received a handbook when you signed up for a plan. If you don't have a copy, contact your personnel or human resources office and request one. If you have an individual policy, ask your health plan to mail a copy to you.
  • Pay close attention to what your plan doesn't cover. Your benefits booklet has a key section called "exclusions." These are services and supplies that aren't covered by your health plan. This is an important section to study before you have any major procedure or order any medical equipment.
  • Make sure you understand how plan networks work. If you go to a doctor who is out of the plan's network, it will likely cost you much more than if you go to a doctor who is in the network. If you have an HMO, you may get little or no out of network coverage unless it is an emergency. Doctors can resign from a network without notifying you first, so check with the doctor's office at every visit to make sure that he or she is still in the network.
  • When an expense is "covered" under your plan, it doesn't mean that your insurance company will pay the entire bill. For example, a doctor's office visit is often covered by insurance up to an "allowed amount," which may be less than the amount you're billed for the visit.
  • Don't assume that a doctor or hospital will extend you credit for charges that your insurance doesn't cover, even if you're facing medical and financial difficulties. If you ask, you may be able to negotiate an agreement with the provider or set up a payment schedule.
  • If you don't have health insurance, ask to negotiate a price for a medical service before you're treated. Be prepared to provide documents and other proof of financial need. Doctors and hospitals aren't required to negotiate, but you may be able to save yourself money and future hassles by trying to negotiate.
  • Watch out for discount health plans that claim to provide health care coverage. These plans aren't health insurance—they're more like buying clubs that promise a discount if you use participating doctors, dentists, pharmacies and other health care providers. Before you consider signing up, read the fine print carefully and ask your doctors and local hospitals if they participate in the program. Also, check with my office to find out about complaints against discount health plans.
Have additional questions about your health coverage? Contact my Managed Care Patient Assistance Program by telephone at (866) 867-6272 or by e-mail at Navigating the world of managed care and health insurance can be an intimidating and confusing process, especially when you or a loved one are dealing with a serious illness or injury. The Managed Care Patient Assistance Program in my office provides experienced specialists to help answer your health insurance questions.