Do You Understand Your Health Care Plan? Preventive Services Are One of the Best Parts.

Posted by Steven Linowes in nemt, Balancing Cost with Service , Blog , Care Coordination , Keeping people healthy and safe , Population Health , member stories on 11.Nov.15 | 0 Comments

Health insurance is a complicated thing.

People, especially those who are receiving health insurance for the first time, have a hard time understanding it. Deductibles and co-pays are often considered the most confusing part. Sometimes insurance pays. Sometimes you are expected to pay, but when and why? You have to pay insurance every month when you don’t go to the doctor and you have to pay even more typically when you do. It doesn’t seem fair.

In the spring of 2014, the Kaiser Family Foundation did a survey noting the boomerang effect agencies and insurance companies were experiencing with questions post sign-up for insurance. Ninety percent of those programs had been re-contacted by consumers and 44 percent had seen people who did not understand how to use insurance, according to the foundation report that was covered by the Washington Post.

 

So what’s free?

One of the best parts of the Affordable Care Act is what it does to help keep us healthy. It flipped the thinking away from reacting to illness toward preventing it from happening in the first place.  Certain preventive services are covered according to law. No matter how you get coverage, if you have minimum essential coverage, you have free preventive care. You don’t have to pay anything to go to the doctor and get these services. You just need to book your appointment with an in-network provider. There are 15 free services for adults, 22 for women, and 26 for children. It includes annual wellness exams, immunizations, mammograms, and other key screenings according to your age. You can find the entire list here.

 

What’s not free?

What’s not free are your diagnostic services and tests in most cases. For those visits, you often will have a co-pay and you will be charged for the service or test itself if you haven’t met your deductible yet. Most prescriptions aren’t free either. To get a better understanding of what’s considered preventive and what’s considered diagnostic watch this helpful video by Blue Cross Blue Shield of Vermont.

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https://www.youtube.com/watch?v=c3uadpuQdmE

 

Make sure the codes are preventive

If you are concerned about costs and are on a budget, then it’s always a good idea to do some cross checking between your insurance company and your physician prior to your appointment. When you book your preventive exam make sure that doctor is in-network according to their office and according to your insurance company. Next, ask your doctor’s office to provide a list of the services that they would conduct as part of your preventive exam with the insurance codes they intend to use. Then call your insurance company and ask them to verify that these codes are recognized as free and preventive according to your individual plan. If the list matches, you should be all set. If not, ask for the out of pocket charges and check back with your doctor to see if the screening is something you should still do.

 

Never miss out on preventive services

Your monthly health insurance premiums help fund your wellness visits. You’ve paid for them. Make sure you book them every year because you can’t get them back! It’s a benefit that people didn’t always have as part of their plans. Insurance companies didn’t always offer it in the past without cost-sharing. With today’s hectic schedules, working in these exams can be challenging, especially when you feel healthy. However, catching problems early before you notice symptoms often saves lives. Something may be brewing that you wouldn’t be aware of without your exam. It’s a lot easier to curb disease in early stages than it is to deal with it once something’s clearly wrong. Take advantage of this critical benefit and stay healthy.

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