What To Know When Paying Your Doctors

Here are a few tips to arm yourself when dealing with health care providers, insurance companies, and when deciding if you are for or against reform:

The most important piece of information to know is what type of plan you have. Do you have a plan that has in network benefits and out of network benefits? Believe it or not some plans only have out of network benefits? You can and will be penalized for not checking with you insurer before receiving treatment even in emergency cases.

Do you know your appeals process? You always have the right to appeal. Your insurer can provide you with an address to send an appeal request.

Do you have a summary plan with details? Most human resources department can provide with details to your plan. This is important to have because you want to know if the location of your doctor’s visit will be covered. Example doctors offices, outpatient visits, and urgent cares all provide similar services but are billed differently and often have different levels of coverage.

Have you checked to see if you are required to have a primary care physician listed? Or if your doctor is a part of your insurance plan’s network ? All though you may have had the same doctor for five years he or she may no longer have a contract with your insurance plan. Things change annually, please be sure to check an out of network bill is always greater than an in network bill. Call and ask for a provider directory.

Is your policy fully funded or self funded? This is determines if your policy has to abide by state mandates or federal mandates. If your policy is fully funded the insurer must abide by both state and federal mandates, if they are self funded they do not have to abide by sate mandates.

If you are covered by more than insurance please call to find out which policy is primary. There is a coordination of benefits policy all insurers follow. Depending on the type of insurance you have or others in your household have that are covered by you your coverage could be affected.

Finally learn about your insurers preexisting clause.  If you are going to switch coverage find out about what could possibly exclude you and your family from receiving coverage.

 

In the midst of the struggle for health care reform Tuesday October 13, 2009 the Senate Finance Committee passed its version of a health care reform bill with the first round of republican support. There is a hint of bipartisan support and want for reform. This is progress, and could be the foundation for a major win for the American public.

Here are a few tips to arm yourself when dealing with health care providers, insurance companies, and when deciding if you are for or against reform:

The most important piece of information to know is what type of plan you have. Do you have a plan that has in network benefits and out of network benefits? Believe it or not some plans only have out of network benefits? You can and will be penalized for not checking with you insurer before receiving treatment even in emergency cases.

Do you know your appeals process? You always have the right to appeal. Your insurer can provide you with an address to send an appeal request.

Do you have a summary plan with details? Most human resources department can provide with details to your plan. This is important to have because you want to know if the location of your doctor’s visit will be covered. Example doctors offices, outpatient visits, and urgent cares all provide similar services but are billed differently and often have different levels of coverage.

Have you checked to see if you are required to have a primary care physician listed? Or if your doctor is a part of your insurance plan’s network ? All though you may have had the same doctor for five years he or she may no longer have a contract with your insurance plan. Things change annually, please be sure to check an out of network bill is always greater than an in network bill. Call and ask for a provider directory.

Is your policy fully funded or self funded? This is determines if your policy has to abide by state mandates or federal mandates. If your policy is fully funded the insurer must abide by both state and federal mandates, if they are self funded they do not have to abide by sate mandates.

If you are covered by more than insurance please call to find out which policy is primary. There is a coordination of benefits policy all insurers follow. Depending on the type of insurance you have or others in your household have that are covered by you your coverage could be affected.

Finally learn about your insurers preexisting clause.  If you are going to switch coverage find out about what could possibly exclude you and your family from receiving coverage.