Do You Know the Ins & Outs of Your Health Insurance Coverage?
by Susan L Combs
April 29, 2019 .3 min read
Depending on what state you live in, the Affordable Care Act (ACA) has truly made significant strides in covering several aspects of Women’s Health which has landed us where we are today.
Today we live in a world where the consumer drives healthcare, giving us the power to take the driver’s seat. And while we have come a long way within the industry, it's still crucial that you educate yourself on the fundamentals of your plan. Knowing the basics of what your plan provides can prevent or prepare you from any costly surprises that may arise in the future.
Here are a few hot topics that I know many women wish they had been educated on when it comes to their health insurance:
Preventative Care Doesn’t Always Stay Preventative
Under the ACA, preventive care which includes things like In-Network Mammograms, Well-woman checkup, STD Screenings, Colonoscopies, etc., are covered at no cost. However, if something were to arise during your visit, the visit can go from a preventive visit to a diagnostic appointment. With that, you can expect to incur charges for any diagnostic services you receive.
Birth Control is Covered at 100%
This only applies for generic versions of birth control.
If your doctor currently has you on a brand name birth control and you're looking to save some dollars each month, check to see if there are generic alternatives available to you.
If you do, however, need to remain on brand name medication, I advise that you check into mail order options which should be available via your health insurance policy. Typically you can get three months’ worth of birth control for just around two copay payments.
This is something that almost always must be preapproved by your insurance.
I have seen many of my clients get testing done at their doctor’s suggestion but then were later hit with a big bill. The reason for this is because their doctor’s office failed to get them the preapproval they needed or failed to inform them that they needed to contact their insurance company to find out how to get the costs covered.
Most carriers have wellness programs and discounts built into the health insurance plan now. Some ways they have gone about providing these perks to members are via reimbursements to gyms, weight loss programs and/or alternative medicine. So, if these are services you use already, keep in mind that you may be leaving some money on the table. Look into where these discounts apply to you and make sure to pocket back that cash.
This is a hot topic, and depending on your state or the company you work for, this can affect how much of this process is covered.
Often if you are going to an in-network physician, you can get some of the initial testing, medications and doctors visits covered. But when it comes to the actual In-Vitro fertilization process, this is something that you can expect to pay out of pocket.
Many of the carriers out there have this built into the plans now.
This is a quick “on demand" way to see a doctor or mental health professional when you don’t have time to get to the doctor or are living in a remote area.
You can have Skype appointments with a doctor; some carriers even provide you with a thermometer or diagnostic kit that syncs with the app to give the physician further information to provide you with care.
Be Your Own Advocate
Make sure that when you are going to see an in-network physician that all services stay in network.
Multiple times a year I see my clients get hit with bills that they thought were going to be In Network only to find out there is a portion that is out-of-network or not covered at all.
To prevent going out of network, be mindful if you need to have labs drawn. Make sure you tell your doctor you want to use an in-network lab to process your lab results.
Also, if you are scheduled for surgery, make sure you document and tell the facility that you want an in-network Anesthesiologist.
In a world that offers consumer-driven healthcare, you hold the power of being in the driver’s seat. With that, it's your job to become knowledgeable about your options and maximize the benefits available to you. To do that, make sure you check out your carriers websites, which provide a wealth of knowledge. In addition to that, you can also call the 800 number on your insurance card a call. The service representatives are there to help you navigate through your benefits and help you avoid costly pitfalls along the way.
Susan L Combs
I started my brokerage firm at the age of 26 in New York City and the phrase that comes into my mind every time when I think back almost 14 years ago: “I didn’t know what I didn’t know.??? But what I did know was how to treat people since I came from a hospitality background and a solid Midwest upbringing, I decided to build a brokerage firm on that principle.