Getting the Most from Your Insurance

Use Participating Providers Whenever Possible

Insurance works best when you use participating providers: doctors, surgeons, anesthesiologists, hospitals, labs, diagnostic facilities, physical therapists, pharmacies, etc. Use your carrier’s online provider network database to find the most recent list of applicable providers (do not rely on booklets or CDs as they become outdated quickly). Even after locating a provider be sure to confirm plan participation. Be careful, providers may indicate they accept your plan but may still be out-of-network; potentially leaving you with deductible, coinsurance, and bill-balance costs to absorb. Always confirm that they are a network provider with your plan.

Always Check on Services That May Require Pre-Certification

When you need surgery, a lab/imaging diagnostic test, or a procedure (hospital admission, out-patient, or otherwise), always call your carrier beforehand to double check pre-certification requirements. If pre-certification is not required—great! It’s best to double-check and be certain because the alternative can potentially be expensive, not to mention, aggravating.

Keep a Log or Records

When you make any calls seeking answers, pre-certification, claim resolutions, or any other important questions about your insurance coverage, record the date, who you spoke with and the highlights of the conversation. These notes will provide you with peace of mind and provide a helpful place to refer to when going back months or even years if necessary.

Make Your Insurance Premium Payments a Priority

Be sure to make your insurance premium payment is on time to avoid cancellations. Reinstatements are not automatic and may be denied. Most carriers enforce a one-time “non-payment” cancellation in a single year. The second cancellation will create the inability to come back on to the plan for a period of 12 months.

Visiting an Out-of-Network Doctor? Have any Testing done in Participating Lab

If you use a non-participating doctor who requires testing, you may cut your costs dramatically by not having expensive tests performed in their office—on a “non-par” basis. Request that the tests be performed at a lab or imaging center that participates with your health plan. This extra step could save you a significant amount of money.

Use Mail-Order Prescription Benefits Whenever Possible

For maintenance prescriptions, be sure to ask your doctor for a 90-Day prescription to submit to the mail-order administrator. Most carriers can provide a 90-day mail-order supply at a lower price (perhaps a 3-month supply for a 2-month price). Check your plan’s specific mail-order benefit.

Groups of 2 or More Currently Experience Comparatively Lower Rates in New York State

Business with only one person currently experience monthly premiums that can be as much as 20% higher than a group of 2 or more. The addition of 1 or more employees entitles you to a lower rate and will increase the number of plan designs available to you. Call your insurance agent or carrier as soon as you add an employee.

Carry-Over Deductibles

Some insurance carriers may allow the application of a carry-over deductible. If you supply proof that you have satisfied all or a portion of your deductible under your previous insurance plan, that amount may be credited to your current deductible—helping you be “in-benefit” much faster. Not all insurance carriers have this policy so check with your insurance agent or carrier about their policy.

Notify Your Carrier Immediately About Plan Additions or Terminations

Employers should always contact their insurance carrier or plan administrator immediately when adding or removing employees. On the employee level, be sure to notify the appropriate parties about and the addition or termination of a spouse or dependent children (newborns/dependents no longer eligible for dependent coverage). Prompt notification can either save you money or aggravation depending on what event is occurring.

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