Let's face it, in these ever growing hard economic times, most companies that provide health insurance to their employees have had no choice but to cut back on the benefits coverage they offer. When reviewing the benefits being offered to you by your employer, get the answers to these questions so you know what you are being offered.
Also, if you are purchasing a health insurance policy on your own for the very first time, make sure you get the answers to these questions from your agent before you decide on purchasing the policy.
Here are the top 5 things you should ask your insurance carrier before using your insurance for the first time.
1. Is there coverage on my policy for "this/a" specific procedure or treatment?
Please don't just assume that there is coverage for something specific on your policy, as benefits are being removed from policies to save money, but were once considered to be standard on all policies. Let's take maternity for example. There are numerous national and local insurance companies that sell individual policies to people every day that do NOT cover maternity care. Sadly, most people do not find out about this until they are already pregnant. Make sure to verify with the agent if and how a service is covered on a specific plan prior to purchasing it.
2. Is there a pre-existing condition term on this policy, and have I met the determining criteria?
A pre-existing condition is a health problem that you have been treated for, or diagnosed with within 63 days to 24 months prior to the health coverage beginning date.
Basically, anything medical, mental, illness or injury related that was contracted or treated within the 63 days to 24 months time frame can be denied as a pre-existing condition.
If you have something denied as pre-existing, you will need to show proof, in writing from your prior carriers, that you have had uninterrupted health insurance prior to the start date of your new policy. There can not be greater than a 62 day window (the standard in most cases) in your coverage, or the pre-existing condition clause will exclude anything you were treated for prior to the start of the policy. In some cases, this includes diabetes.
3. Am I required to use specific doctors for visits to be covered under my insurance?
Many people do not know that with every health insurance they carry, there is a specific "network", or list of doctors that they need to use to minimize their medical costs. The best thing to do in the event that you need to use a doctor of facility is to call your insurance company to find out if there is a certain network that needs to be utilized prior to using a doctor. If you call the customer service number on your ID card, they can usually tell you if there are specific doctors to use. They can also assist you with locating doctors in your area. The best way to handle this is to make that call as soon as you get your insurance to avoid being rushed if you are ill or have an injury.
4. Do I need to use a specific laboratory for blood work and lab tests?
This again falls under the "network" doctors scenario. If you do indeed have a specific network to use, you can call your insurance customer service and find out in advance which laboratory in your area is the correct laboratory for you to utilize. Understand that in some cases, the hospital may be the most expensive cost option for laboratory tests.
5. What will my out of pocket expense be for the following treatment facilities?
Prior to using your insurance, you should have an understanding as to what your financial responsibility will be for each of the following. You can get the cost information by calling the customer service number on your identification card, and be aware; this is only a partial list of possible treatment options.
- A family physicians office visit
- A specialists office visit
- A laboratory visit for blood work
- An emergency room visit
- An in-hospital stay
- An out-patient hospital visit
- An urgent care visit
- An imaging facility visit
You should fully read and understand your health insurance policy before using it the first time. In the event that the insurance terminology is confusing to you, you should call the customer service number on your insurance card and ask them as many questions as it takes to answer everything that is on your mind. The insurance companies use your premiums to pay their employees to answer your calls and explain your insurance to you. If you ever get into a situation where you are not getting satisfactory service, please ask for the representative's name, and then ask to speak to their supervisor. Your premiums pay them to do their job, get what you are paying for.
Best wishes for your long and continued good health.