Working with Your Health Insurer

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Here are some ways you can work with your health insurer to stay healthy and reduce your medical costs.

Understand Your Health Plan

  • Use network doctors – Most plans have a network of doctors, hospitals, and other healthcare providers. Using network doctors will save you money, since in-network services are usually covered with lower out-of-pocket costs. Typically, the insurer’s website will allow you to search for network doctors.
  • Know your plan – When you enroll in a health plan, you may receive written materials about your plan, and you can also find information on the company website and by calling the insurer’s customer service department. If you have any questions about your coverage, don’t hesitate to ask for more information.
  • Take advantage of the “extras” – Many health plans offer programs and services to help you maintain good health, such as special discounts for weight loss programs, online wellness resources, community health screenings, and much more. These added benefits are a valuable part of your plan—check them out and use them!

Know Your Rights and Responsibilities

  • Coordinate your benefits – If you are covered by more than one health plan (including Medicare), you will be asked to provide this information to both insurers so they can coordinate your benefits. This will help your primary insurer pay claims promptly.
  • Read your benefits statements – When you receive an “explanation of benefits” statement,take a minute to review it. This statement lists the medical service provided, the amount paid by your insurer, and any amount you may be required to pay—but it is not a bill! Your explanation of benefits can also help you and your insurer spot incorrect or false claims. If you did not receive the service listed, or have questions about the payment, contact your insurer.
  • Know your right to privacy – The Health Information Portability and Accountability Act (HIPAA) includes rules to protect the privacy of your medical records, including medical claims. Your insurer will give you a copy of their privacy statement, or you can find it on their website. You can read the Blue Cross privacy statement here.

Be a Smart Healthcare Consumer

  • Choose a primary care doctor – Your primary care physician (PCP) is the doctor you contact first when you have an illness or injury. He or she will help you stay healthy, diagnose and treat common medical conditions, and refer you to a specialist when necessary.
  • Seek the right level of care – In a true medical emergency, always go to the emergency room.But if you need immediate care for a medical condition that is not life threatening, contact your primary care doctor, or if your doctor is not available, head to an urgent care center. You will get faster care and reduce your medical costs by seeking the right level of care for a sudden illness or injury.
  • Ask for a second opinion – If you want another doctor to evaluate your medical condition,you can ask for a second opinion. Both your doctor and your insurer will support this decision.
  • Reduce prescription costs – When your doctor prescribes a medication, ask if a generic version of the drug is available. You also can reduce costs if your healthcare plan offers a discount for prescriptions filled through a mail-order pharmacy service.