Monday, January 07, 2013

Insurance Out of Pocket Cost Management

I used to be a low maintenance medical needs person. I didn't spend much time checking on my health insurance benefits since I rarely needed a new doctor, medicine or hospital.    However, a recent change in my health situation requires me to have much higher use of the health care system, from health care providers to prescriptions.   So now I am more attentive to the various aspects of our health insurance plan.  

So here are the items that I am now checking:
  • Network provider.   In network means my insurance company pays a negotiated rate and I pay a copay at a flat rate or a percentage.   Out of network means I pay a percentage of the provider rate up to a deductible maximum.  
  • Procedure codes.   Insurers need to know the specific procedure to know whether it is covered and for how much.   I learned that saying "a root canal" or "a stress test" was not sufficient information.  I needed to know the specific numerical code that is being performed.  This code is available from the provider.
  • Generic availability. My insurance will pay for both branded and generic prescription drugs.  However, when both a branded and generic version is available, the benefit is less for the branded version. 
  • Fortunately, I have excellent retiree insurance from my company.  All the doctors and hospitals in the area are network providers.  So I can focus on finding the best providers because the cost will be the same.  However, I am still interested in my out of pocket costs.  So I will ask about the procedure codes and generic availability when working with a provider.

    For more on Strategies and Plans, check back every Monday Tuesday for a new segment.

    This is not financial, insurance, or health care advice. Please consult a professional advisor.

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