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.

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

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