Is it me or is health insurance a bear to deal with?

This is a question that I often ask myself both from a personal and professional standpoint. It isn't you, it's them. Not to sound like a cliche, but you aren't going crazy. Healthcare, insurance, managed care- it is difficult to understand the in's and out's of the following:

  • Your benefits
  • How your claims are processed
  • If your claims are processed correctly
  • How to see practitioners in-network vs. out-of-network

I wish that I had been taught this in my graduate work when becoming a healthcare practitioner. Unfortunately, we have to go through a lot of trial and error before really grasping all the above issues. So, let's talk about how to cope with understanding your benefits, what should be expected of you from your insurance and your healthcare providers, and how to advocate for yourself.

1) Benefits: It's important that you work closely with your Human Resources, employer, or whoever manages your healthcare benefits. If you are self-employed or using the Affordable Healthcare Act insurance, you should make yourself familiar with what premiums you are paying and what your benefits include. Remember that medical benefits can be/often are different from your mental health benefits. Call your the 800 # on the back of your card, get a listing from your HR, or sign up online for your health insurance portal to familiarize yourself with copays, coinsurance, deductibles, and out of pocket max's. 

2) Expectations of Insurance/Healthcare Providers: Often you will have what's called a deductible which means you must reach a certain dollar amount before insurance will actually kick in and start paying. That means you will typically have to pay out of pocket for all services until this deductible is met. Make sure that before you make an appointment or go to a hospital, find out if they are in network or out of network. Rule of thumb is that it will cost you less to see someone in network. You will also want to make sure you understand what payment will be needed up front if you do indeed have a deductible. It is also important that you follow what's called your EOBs or Estimation of Benefits. This will help you understand what practitioners are billing for, how much you might owe, and where you stand on things like deductibles and out of pocket max's. 

3) Advocate: No one will fight your battles with insurance accept for you. That is the hard and brutal truth of it. Be sure to document any time you call your insurance company with date, time, and who you spoke to. This is extremely helpful if you need reference it in the future. Keep track of your deductible and out of pocket max's by keeping up on your EOBs or signing into your online portal. Don't be afraid to ask questions- and you can always ask for a supervisor if you aren't getting the answers you need with your insurance company. If your insurance is through your employer, they can also help to advocate for you if you are having difficulties.

As this is just a glimpse into how insurance works and how it can be a bit frustrating, more blogs will be written with more in depth ways to keep up on your understanding of your benefits and out of pocket costs. If ever in doubt, talk to your practitioner/provider/hospital, and they can often help you out on their end too. If nothing else, don't get discouraged. Document, document, document AND ask questions whenever/wherever needed.

See more posts about:
No items found.