Health Insurance Pointers-Part 2: The Commercial Insurer

February 28, 2019 | Office News

If you have commercial health insurance and you have selected your health insurance plan for this year, it is also important to review and understand your individual health care benefits. Even those whose plans stayed the same should review the pointers below.

1. Review your benefits and see if anything has changed. Many times, plans may change preferred providers as well as preferred pharmacies. A list of in-network providers can be obtained by calling the customer service phone number on the back of your insurance card or by going to the insurer’s website. Always check both the group number as well as your pharmacy provider on your insurance card as these may change even if your plan stays the same.

2. Review your deductibles. Yes, deductibles can change from year to year. This becomes important because this is the total dollar amount that needs to be paid by the patient first–before any benefit from the insurance company begins. In addition to this, many policies have a co-payment for services. This is the amount the patient pays at the time of service and may be counted towards the patient’s total out-of-pocket. Even though the co-payment is made, that alone may not satisfy your total financial obligation for the office visit.

3. Review and understand your policy and know if it is an HMO or a PPO. Keep in mind that HMO’s require referrals from your primary care physician before going to a specialist. Ignoring this referral process may result in a denial of coverage or additional out-of-pocket expense. Some HMO insurances companies may now require an electronic referral from your primary care physician instead of a paper referral.

4. Finally, make sure you have your most recent insurance card with you. Even if your provider and/or plan have not changed, it is still possible that your group number or the insurance companies’ phone numbers may have changed.

Understanding your coverage can help you make the best decisions for your healthcare needs. As always, we are here to help decipher and answer any questions you may have.

Practice Manager