Tips for Choosing Health Insurance
BY NEVA FORRESTER
Health insurance premiums keep rising, and it seems like the actual coverage offered for services from these plans is diminishing. The cost, the fine print – it can all be very confusing and extremely overwhelming.
When you’re shopping for a new policy, here are some tips and questions I recommend keeping in mind:
Prioritize Your Favorite Doctors
Finding a good doctor that you’re able to bond with and that understands your needs and respects your wishes can be difficult, and dare I say it, rare. If you do have a relationship like this with one of your doctors, here’s how to make sure their services are reimbursable under your plan.
- Use the “Provider Search” on the health plan websites. Input your doctor’s name and location, and it should show you if they are contracted with the plan you are looking at or not.
- Call your doctor’s office to see if they participate in that specific plan. You should also ask if they intend on continuing their participation as it is not uncommon for doctors to be in-network one year and out-of-network the next with reimbursement amounts and billing requirements changing often.
Note: Understanding the difference between in- and out-of-network is important. If you have an HMO policy, only in-network providers will be covered. If you have a PPO plan, you are free to see any doctor you’d like. More often than not, reimbursement rates and out-of-pocket costs are generally higher for out-of-network providers. Additionally, most plans have separate in-network and out-of-network deductibles, respectively.
Services
Are you on a regularly taken prescription? Do you have a standing appointment with one of your doctors regularly? Perhaps your chiropractor or acupuncturist?
If you have specific medical needs or services you utilize regularly, it’s essential to look a little deeper into the health plan documents and benefit information. Here are a couple of questions you can ask while reviewing:
- Is my service covered?
- At what rate or percentage?
- Is the service subject to any deductible?
- What is my cost (copay/coinsurance)?
- Is there a visit or dollar limit on the service?
- Does this service/product have specific requirements for reimbursement (i.e. diagnosis, referral, treatment protocol, etc.)?
In my experience, most people become frustrated not knowing the details. Plan documents can be incredibly grueling to read, but unfortunately, it is ultimately your responsibility to understand what your coverage entails. Good doctor’s offices and facilities will help you understand these specifics, but it is smart to have an idea of what to expect before you go in for a service. How many times have you gone to the doctor, maybe paid a copay, then received a bill for a few hundred dollars months or even years later? Having at least minimum knowledge of this information also puts you in a better position to recognize when an office may be misquoting you for costs.
I also recommend paying close attention to the little phrases insurance companies like to use in their benefit descriptions. For example, you could be one of my patients with chiropractic coverage “up to” 20 visits per calendar year. Were the italics dramatic enough? These two words mean you have the potential for coverage up to 20 visits per year based on the health plan’s determination of medical necessity. Your insurance company holds the power to decide if you need a particular service or not, even though they’ve never met you. Even if your doctor says you need it. How uncool is that?
Consider Premium Cost vs. Health Needs
Health insurance is expensive. Especially so if you don’t have an employer contribution. If you are generally pretty healthy and don’t have needs that extend beyond the basic annual exam and bloodwork, it’s hard to justify paying for a high premium health plan when you know you won’t be utilizing the majority of the offered benefits.
If this sounds like you, I recommend opting for the cheapest premium plan you can find. Your deductible will most likely be astronomical and likely unattainable unless you experience a life-threatening event. They aptly call these “catastrophic coverage” plans. These allow you to save significantly on premium costs while still providing a sense of security, knowing that if something really does go wrong, you at least have some sort of policy to fall back on.
Prompt Pay or “Cash” Discounts
In some states, providers are authorized to offer a “prompt pay discount” for health or medical care. These discounts are great if you have one of the above-mentioned high deductible plans, or if you don’t have insurance coverage for a specific service or product. Check with your favorite offices to see what kind of prompt pay discounts they offer – sometimes they can even be cheaper than your copay/coinsurance amounts!
Prompt pay or “cash” discounts cannot be combined with any insurance policy. Providers are required by law and legal contract to collect any and all amounts deemed as the patient’s responsibility once the claim has been processed. Failure to do is considered insurance fraud, and you should be weary of any offices that offer this combination. In the event of a provider audit by the insurance company, health plan subscribers can be balanced billed for the remaining cost of what wasn’t collected.
None of it is Great
Every year I have patients, friends, and family alike all reach out to me about how to navigate choosing a health plan that would work best for them. While I wish I had the brain capacity to know the intricacies of every single health plan out there, it’s just simply not possible, and honestly, no one can determine what works best for you, your family, and your budget better than you can.
Your return on investment for insurance is almost never equitable, however, there are unexpected life circumstances that make having even the simplest of policies worthwhile. By keeping these pointers in mind, you can at least make sure you’re getting the most for your money.
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