June 5th, 2019 BY HealthNetwork
Whether you’re fresh out of school and starting your career or you finally landed a job that includes full benefits, getting your first health insurance policy can feel like a big step into adulthood – and kind of overwhelming at the same time. There’s nothing like the peace of mind that comes with knowing you and your family are covered in the event of an accident or illness. But now that you have healthcare coverage, what do you do with it?
Know Your Policy
When you join a new healthcare plan, you will receive a copy of your policy. This document is loaded with important information you’ll need to know. There’s plenty of small print in a health insurance policy, but unlike the “terms and conditions” you never read on app downloads, it’s important to read through this policy carefully to see what you’ve just bought.
Some important things to learn are what services are and aren’t covered, what your portion of the costs will be for different services, which doctors and hospitals are part of your plan’s network, the deductible amounts and any restrictions on coverage for certain things. The Affordable Care Act requires major medical insurance plans to cover 10 essential health benefits, but coverage for these services will vary by plan. Short term health insurance doesn’t have to adhere to this rule, so read your plan documents carefully if you’ve bought temporary coverage. And make sure to keep a copy of your plan in a safe place for future reference.
Upon receiving your coverage, visit the insurance company’s website to set up an account. Most, such as United Healthcare, allow you to create an online profile and track important data, like the amount of your yearly deductible and how much of it you’ve met as the year progresses.
You may also find useful information about general health topics such as weight loss, eating healthier and how to fit exercise into a busy schedule. Some insurers even offer their members “health hotlines,” which make nurses or other healthcare providers available to answer health related questions when your doctor isn’t available. Take advantage of these and other added features to really make the most of your coverage.
Carry Your Insurance Card
When you receive your insurance documents, they should include an identification card that indicates you have coverage though that insurer. It’s important to carry this card with you because it serves as proof that you have coverage, especially in an emergency or when you’re traveling. Medical providers will use the information on the card to bill your insurance company for their portion of your medical bills.
If you’ve got a baby or young kids, stick a health plan ID card in your diaper bag or the bag you use to carry snacks and that change of clothes you hope you never need. That way, you’ll have it on hand if you need to make an unexpected trip to the pediatrician’s office.
Learn Your Network
In an effort to keep costs in check for their members and their businesses, insurance providers will often require you to use a doctor and hospital that’s in your network. This network of healthcare providers will be found in your policy documents, and there are usually plenty of providers to choose from. It’s important to understand a little about what a network is and how it works with your health plan.
Basically, the insurance company has entered into an agreement with doctors, hospitals and other healthcare providers to set pricing for their services. If you see a healthcare provider inside your network, you will pay the lowest copay or percentage of payment allowed by your policy. If you opt for a non-network provider instead, you’ll pay a much higher percentage or copay, and some services might not be covered at all outside the network depending on your plan type. Emergencies should be an exception to this rule, but it’s not a guarantee. Stick with your network if you can.
Find a Doctor
Once you understand the network limitations, look for a primary care doctor. Establishing a relationship with a doctor is important. For starters, it sets a baseline for tracking your health. Annual wellness checks, which are covered without any copays or cost sharing under the Affordable Care Act for major medical coverage, will help your doctor see how you’re doing and notice any changes from year to year. Choosing a primary care doctor can also lower your overall medical costs since these doctors will find health problems early when they’re less expensive and less complicated to treat.
Not sure how to pick a provider? Do a little research, talk to your friends and coworkers, read reviews online, decide on a doctor and schedule a routine checkup to get started. You may want to go with a facility that has multiple providers because it allows you to see someone else if your doctor isn’t available, or you might like the more intimate feel of a private practitioner who works solo.
If you have a family, finding multiple doctors might be necessary. Your network should have general practitioners, pediatricians and gynecologists among its network providers, not to mention specialists and surgeons if you need more specific care. Knowing which hospital(s) in your area are part of your network is also important. The same rules apply to hospitals. If you go outside your network, you will pay more for services. Unless it’s an emergency, plan ahead to know which hospitals are covered by your plan.
And take note: Doctors don’t always have the same access rights to all hospitals in the area, and your in-network hospital might not staff doctors that are also in your network. Make sure your doctor and your hospital get along and that everyone in your medical team is covered by your plan. Otherwise, you might be paying out of pocket for surgeries that your in-network doctor recommends.
If you have a specific problem, like foot pain, and want to see a podiatrist for care, review your policy ahead of time. Some insurance plans require that you see your primary care physician first and get a referral to see a specialist. Other plans might allow you to see a specialist without a referral. It’s important to understand what your plan covers and what’s required ahead of time to avoid delays in treatment, problems with paperwork and coverage disputes.
Having health insurance is an important part of being a responsible adult. It only takes one significant medical problem to change your life and financial situation forever. Once you have health insurance, learn everything about your particular policy as soon as you receive the documents. If you have questions, just ask. There should be a number on the back of your health insurance ID card and a website for more information. Knowing your policy will help you avoid mistakes and misunderstandings when you’re seeking care.