This article’s purpose is to help you understand the five most important things about your health insurance in an emergency. This piece covers various health insurance concerns such as common healthcare terms, where to go for help, and keeping a medical history.
- Know how your plan works
Before you find yourself in an emergency it is important to prepare by researching a little more about your specific health insurance plan. Many plans offer valuable information online through their own websites, and many continue to offer help lines wherein members can call and speak to a representative about any questions they may have. Some important questions you may want to ask include;
- What does the plan cover?
- What benefits are included in the plan?
- Are there any restrictions in this plan?
- Which doctors are in my network?
- Common healthcare terms defined
When reviewing your health insurance plan you may come across certain health care terms that you may not know the meaning of. Oftentimes these confusing terms are essential to understanding your plan, thus we at Digital Strategy Yoga have created a list of the five most confusing terms and have provided definitions for each term below.
A Premium is the amount an individual pays to their health insurance company to keep their policy in effect. Premiums are often assessed on an annual basis but may be paid monthly, quarterly, or biannually depending on an individual’s insurer.
A Deductible is a fixed dollar amount that an insured individual pays for out-of-pocket each year before their health insurance plan begins to make payments for covered medical services. For instance, if your deductible is $1,000, your insurance company will not pay for any of your care until you pay $1,000 out-of-pocket in medical costs. Typically premium payments do not count towards the deductible; however once it has been met your insurance company will cover any future medical costs.
Co-Insurance is the amount an individual is obligated to pay for covered medical services after they have satisfied any co-payment or deductible required by their health insurance plan. Co-Insurance is usually expressed as a percentage of the charge or allowable charge for a service. For example if an individual’s insurance company covers 80% of the allowable charge for a specific service, that person is then required to cover the remaining 20% of the bill.
A Co-Payment is a fixed dollar amount an individual must pay when a medical service is received. This is a form of medical cost sharing in which an insured person pays a portion of their bill after their deductible has been met. It is important to note that there may be separate co-payments for different services; however most plans have fixed rates, such as $20 per office visit.
- Out-Of-Pocket Maximum
The maximum dollar amount a group member is required to pay out-of-pocket during a year.
Until this maximum is met, the insurance plan and group member share in the cost of covered expenses, such as co-payments and co-insurance. After this maximum has been reached, the insurance company will pay for all expenses for the remainder of the year.
- Where to go for help
It is imperative to know where to go when you or someone you know is in need of medical care. Oftentimes it is clear what treatment is needed, however it may be unclear at times. Knowing the variations between each option and deciding where to go can make all the difference in cost and time. The key point to remember is to be prepared before you visit and to call ahead of time to ensure you will be covered by your health insurance plan’s network. Listed below are four healthcare options often sought out by patients, along with a short description of each option;
- Your doctor
Your doctor or general practitioner should be your first choice for non-emergency care. Most doctors’ offices are moderately prices and average a waiting period of 24 minutes. This type of care has strict hours but offers the greatest access to resources such as prescription medication and referrals to specialists. Patients should visit their primary doctor for health issues such as; cuts and scrapes, cold and flu, minor burns, ear or sinus pain, shots, sore throat, stomach aches, minor allergic reactions, and physicals.
- Retail clinics
Retail Clinics, or convenient care clinics, are a category of walk-in clinic located in retail stores, supermarkets and pharmacies that treat minor illnesses and provide preventative health care services. An example of this type of clinic is the “Minute Clinic” located in most CVS retail store locations. Typically these clinics are used for care when you can’t see your doctor and average a wait time of 15 minutes. These clinics are usually open later than doctors’ offices and are a good option for care due to their cheap nature. Patients should visit a Retail Clinic for health issues such as; infections, minor injuries or pain, shots, cold and flu, sore and strep throat, and allergies.
- Urgent care
Urgent Care is a type of walk-in clinic in which individuals with a non-life-threatening illness, injury, or conditions can receive immediate care without having to spend the day in the emergency room. Typically these centers are moderately priced but they have a shorter waiting period, averaging around 11 to 20 minutes. These clinics are usually open longer hours during the week and on weekends so they are a good option for care when the doctor’s office is closed. Patients should visit an Urgent Care clinic for issues such as; migraines or headaches, back pain, cuts that need stitches, sprains or strains, and animal bites.
- Emergency room
The Emergency Room is used for serious, life-threatening issues only. Typically visiting the Emergency Room is extremely expensive and has a long wait period before you can see a doctor, averaging around four hours waiting time. Patients should only visit the Emergency Room for serious issues such as; heart attack and stroke, head or neck injuries, problems breathing, seizures, broken bones, uncontrolled bleeding, severe vomiting and diarrhea, and sudden or severe pain. If it is not an emergency you may be able to save money by seeing your regular doctor for colds, minor sprains, and other less sever conditions than the ones listed above.
- Keep a personal medical history
Keeping a written personal medical history can improve the health care you receive and help you stay well. It is also the best way to make your information up to date and more readily available to pass along to doctors and nurses. Having a record of your health is especially helpful when you have limited time during a doctor’s visit. Knowing which shots and treatments you’ve already had helps keep your doctor from unnecessarily repeating them. Writing your own records is also helpful when traveling or if you switch doctors and your office medical records get lost. Typically in your personal medical history you should track;
- Illnesses and injuries
- Treatments and therapies you’ve had, including results
- Prescription drugs you’ve taken, including results and side effects
- Health screenings and results, physicals
- Current weight
- Allergies, including drug allergies
- Tips to take advantage of your health insurance benefits
After researching many options online we at Digital Strategy Yoga have compiled the four most helpful tips to help you take full advantage of your health insurance benefits.
- Stay in the network
Most health insurance plans use a certain group of doctors, hospitals and other health care professionals called provider networks. If you need to visit a doctor outside of this network then you may have to pay more for your care, or even the full cost because the health insurance company will not pay for these services. It is important to review your plan and ensure that any doctor or specialist you need to see will be covered in this network of providers.
- Know what is covered
Ensure that needed services or treatments are covered before you schedule them. Depending on your health insurance, you may need Prior Authorization from your plan before you can get certain tests or procedures done. You or your doctor must send in a Prior Authorization request form in order to receive approval for these tests or procedures.
- Understand health insurance costs
Health insurance costs can be confusing, but it doesn’t have to be. Knowing what premiums, deductibles, co-insurance, co-payments, and out-of-pocket maximums are can help you understand how your plan works. Refer to section two of this article to review what these terms mean.
- Conduct an “annual check-up” of your health plan
It is important to make sure your plan still meets your needs. This is especially true if you have had a major life event such as a birth, death, marriage, or divorce. Generally health insurance plans offer phone numbers to call to speak to a representative to ensure your health plan is still relevant to your needs.