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How To Manage Your Health Plan

 Managed care can often feel like your health insurance plan is managing you. Finding your way through it can be like weaving your way through spider webs in a haunted house. Once you are done being entangled and entrapped in one web, you feel like there is another one to walk through. So much is happening around you that you don't understand. Once the lights are on, you see that everything wasn't as scary as you thought. Shedding some light on your health care plan, too, can make it seem less frightening.

1. Pay Attention When Selecting Your Plan. When providing you with information about your employer-sponsored, private pay, and even government-backed health plans (like Medicaid), you are usually given a grid. The grid shows what is covered at optimum levels and lower levels of plan payments and coverage. Take the time to read the grid. Reading it isn't fun or interesting, but it will pay off in the long run. Be honest with yourself about your healthcare needs. If you have a pre-existing condition and you know that you are going to have to have a lot of visits to your primary care provider, choosing the highest deductible plan is probably not the right choice for you. You also want to consider your own family finances. Can you really afford a $10,000 deductible just so you can pay $50 or $100 less a month in insurance? You have to look at both the short-term and long-term costs of insurance and healthcare coverage. 

2. Read Your Health Plan.  It's a good idea to read through your health plan before you sign on the dotted line. The same is true for any type of insurance. You want to make sure you know what is being covered when and by whom. No one really likes surprises when going to the doctor. Moreover, when you are under stress and worried about what is going to happen in an emergency or crisis situation or when you are sick is not a great learning environment or a good time to make decisions. Read through the plan and take notes. Write things down in a way that you can understand them and that you can quickly reference them later. You may want to include a reference section in your healthcare binder or healthcare app that discusses the areas covered in your health plan. You should definitely know what vaccinations are covered, what preventive measures are covered, and what visits you will have to pay for up-front versus a copay. Some insurance companies provide copay information on the insurance card, and others do not. 

Image by MichaelGaida from Pixabay 

3. Ask Questions About Your Health Plan. You should take an active role in all aspects of your healthcare, and your health plan is one of those areas. If you read something in your plan that you don't understand, call the health plan and ask them questions. The health plan has staff that is specifically there to answer your questions. That is what they do all day every day, answer questions customers have about their health plans. Don't be afraid to call or go online and chat with customer service representatives. Health plans are a service provided to you, and you are investing your money in your health. You have a right to know how your money is working for you and how your health plan is working for you, too. 

4. Don't Expect Your Provider To Know. Next time you go to see your provider, look around the waiting around. Count how many people are in there. That's probably at least as many health plans as your provider is dealing with every day. Unless the provider is solely a government-backed insurance organization and only accepts Medicaid and Medicare (which is highly doubtful), the provider has multiple plans that are used in their healthcare organization every day. Health plans contract with doctors' offices and other organizations and set pricing based on something called actuarial risk. That means, they do "fancy math" and figure out what the average risk is for different people with different health conditions. They make payments and set rates based on that. They also assess that risk for each provider. A provider is most likely to be very honest with you when they say they do not know if something is covered under your plan or how much will be covered. Most providers will refer you to the patient billing or finance department, which is the best place to start anyway. Individuals in patient billing, coding, and finance take medical diagnoses, assign codes to those diagnoses, and then submit those codes to health plans for payment. They are the experts on health plans and payments, and many providers defer to them and trust them to have the knowledge and skills regarding health plans. 

5. Follow-up With Your Plan And Provider. Even with the best intentions, things don't always work out with your health plan after a visit to your provider. You may be upset or you may be confused about what happened or how you were billed or why certain items were not covered. The best course of action is to follow-up with your provider or your plan. Remember, you are the customer, and you have a right to know. Also remember, though, that these people are professionals and very knowledgeable about what they do. They are not out to get you. They are out to help you. Come at the follow-up or concerns with an attitude that you want to learn, discuss, and resolve any issues. At times, the follow-up or making calls may seem frustrating to you. In the end, ask yourself if the phone calls or time spent online are worth your effort. If you received a hospital bill for $50,000, isn't it worth ten or twelve phone calls to understand where your $50,000 is going? Your money is definitely worth a few hours of time. The most important thing to keep in mind is that this is your money and your health that is on the line.