I take for granite the fact that not everyone is as keenly in tune and aware of their own health insurance benefits as Andrew and I have become over the past year. Not a day goes by where the Post or the Times are not covering some sort of political matter on the happenings of the new Obama health initiative and its overall ramifications over our personal health coverage. Health care is not a given for all people in this country yet those who do hold the 'golden ticket' do not always understand, ask questions or even challenge the authority of the health care industry so that they too can better comprehend their own personal health care coverages.
Knowing the in's and out's of your own health care plan should be a mandatory priority of each 'ticket holding' individual in this country. It should be no different than knowing your address or phone number. Relying on the health care providers to actually 'provide' you with the answers in a timely matter is sometimes too late. You wouldn't prepare for a meeting the day after it happened, so why would you call to better understand your coverage after the procedure was preformed.
So here are some tips to help you better navigate through the mountain of documents that make up your health care coverage and how to make sure your own doctors are using only those labs that take your health care .... and what to do when they don't .....
1. Reading the pages upon pages of your office's health care plan may put your head into a tail spin and the sheer volume of literature may turn you off from ever wanting to learn more ... instead of giving up, find out who in your own office is the Health Care Benefits representative. It may be your HR rep or someone in a high position. But also remember to find out who that person reports to. For example, if you work at a branch office, then find out who at the national headquarters is the main benefits rep or if you work at a university, who in in charge of wellness and benefits and write that persons name down.
2. Once you have narrowed down who that person is, ask to set up a meeting with them or to have lunch to talk about your health benefits plan. And don't forget to ask if your significant other can attend the meeting too. If you have a joint health care plan, like Andrew and I do, make sure that both parties involved understand the perimeters of the plan.
3. And don't forget about the website. Every health insurance company have a website. It usually just takes a few minutes to set up your account and you can access what doctors are in your plan and what phone numbers to contact in case of an emergency in minutes. These sites can also help track any contested health insurance claims. They are very helpful especially when you are doing research on your own. They can help to answer both simple and hard questions alike.
4. Take notes and ask questions ..... You may not have anything wrong with you now and you may only go to the doctor once a year for a check-up but ask questions for the future. If my wife gets pregnant or what if the baby has complications? or if we get into an accident and I need to take time off work? Find out how your companies handles those bumps in the road before they happen. The problems themselves are 'shock and awe' enough ... finding out that you now have to deal with the health insurance company to find out and fight for your rights can put a strain on you and undue pressures on your already delicate situation.
5. Make sure the doctors you already see are covered under your health insurance plan. You would be amazed at what doctors do and don't take. Do a self check-up for yourself before scheduling any appointments or scans. It usually just takes a check to the insurance companies website and a call to the doctors office itself to make sure that everything is covered.
6. Also remember to check up on what the co-pay for each appointment will be. For instance, with us, a normal doctors appointment is $20, but to see any sort of specialist is $30 to $50. Know what it is going to cost before you go. Hidden fees are the worst. Ask the receptionist taking your appointment what it will cost and check the front of your insurance card to verify the amount. If you are still concerned, call the toll-free number on your card and talk to your benefits representative about how payments for your coverage works. It's better to know now, then pay later. And with that in mind, know what your maximum coverages are for a year ... and for a lifetime. They may seem high and out of reach, but you would be surprised how much hospital visits, doctors visits and tests can add up quickly. Also remember to keep a check regularly so you always know where you stand.
7. As for scans or scheduled tests that your doctor may recommend, always make sure that these procedures are performed at a facility that takes your insurance. You will always be safe if you have anything done within a hospital that takes your insurance, but if you are having something done at for example an MRI center or CT center, always to a check yourself to make sure they take your insurance. Just pick up the phone and call and ask. It only takes a minute but can save you a lot of headaches in the end if you either show up and find out you cannot have the procedure done or that you need to reschedule with another place. Also remind the receptionist at your doctors office which insurance you have before they schedule the scan for you. They see so many patients a day, it is easy to mix them up. I always wait while the scans are being scheduled so I can overhear the scheduling and make sure the right information is being presented.
8. Speak up .... and use your voice!! Question everyone. Doctors offices may do these things hundreds of times a day, but you don't!! Remind them of that. Don't let anyone talk down to you or fluff off your questions ... and make sure they know that. Ask how they will bill and code your procedure and what to do or who to call in their office if it is not coded or billed correctly. Meet that person if possible so they can put a face to the name when you call. And if you are anything like me, they won't forget your face .. or your name ... and will probably be fearful if you call and ask for them ... I keep everyone on their toes and accountable for their actions. But everyone makes mistakes and when you are working with coding numbers they are easy to transpose ... and then you get a huge bill.
9. Leading me to my favorite saying ... if it looks like a duck and quacks like a duck ...then its probably a duck. What I mean is that if you have health care coverage and you receive this astronomical bill in the mail ... there is probably something wrong, especially if you checked off all of the above steps before proceeding with the procedure. But don't panic .... be calm and make some calls. Start off with your doctors office. This is where investigative journalism comes in handy. Speak to the coder and find out what numbers they used to code ... then call the insurance company and find out what those specific numbers are not covered under your plan. It may be that they now use a new set of numbers that your doctor may not know about and all that has to be done is that the claim just needs to be resubmitted. Easy!! But if there is a bigger problem, get the name of the person and the direct number at the insurance company hot line that you just called, call your doctors office and have them talk together, with you on the line, and work this out. Usually your doctors office will know more about the coding system than you. You may also need to contact your office Benefits rep and make them aware of the issue. They may be able to step in and correct the problem as well. Just remember to speak up .... and question your bills... because if you pay the bill without contesting it, you will never see that money again.
This is not a perfect system but at least I hope it gets everyone thinking about their own health and health insurance plan. Andrew and I had never given our personal coverage a second thought until a year ago when we had to learn some things the hard way. You don't have anything if you don't have your health .... so take it seriously!!!
Stay tuned!!!!
