First things first: Obtain a copy of your plan summary from human resources or directly from your insurer. Take the time to read the policy and if you don’t understand something be sure to ask questions.
Know your plan
Doctor’s offices are not perfect and sometimes mistakes are made on your bill. Always ask for an itemized statement and review it to make sure all of the services were provided. The following notes may help you save on your out-of-pocket costs:
If you have a hospital stay planned, ask if you can bring your own regular medications. Hospitals charge by the pill and you could easily pay double what the medications cost you at the pharmacy.
Go to an in-network provider whenever possible. The insurance companies negotiate fees with doctors and decide on a reasonable price for services rendered. When you go to an in-network doctor, she may not bill you for anything other than your deductible, copayment or coinsurance. If she bills you for a higher amount than has been agreed, she must write off that amount. The doctor is not allowed to bill you for it.
Know your keywords
Copayment is a set fee that you pay for each doctor’s visit or for each medication.
Deductible is the amount you must pay before payment coverage starts. Check your plan to see if doctor’s visits and emergency room visits are paid before the deductible is met; you still have the copayment for the visit and any coinsurance will apply.
Coinsurance is the percentage of the bill you must pay. An example: For an in-network provider, you may have to pay 10 percent of the bill and for an out-of-network provider you may have to pay 20 percent. Each insurance policy is different. Once you have met your out-of-pocket maximum, the coinsurance and deductible are waived.
Contribute to a flexible spending account for medical fees. You can contribute up to $2500. If you are married you and your spouse may each contribute $2500. Depending on your plan, you may now be forced to meet a deductible before any medical fees will be covered, even doctors visits. (Note this is not how every plan works; each one is different). I have seen posts on Facebook where premiums have gone up so there will be less to bring home in a paycheck; to make matters worse they must also meet their deductible before their costs are covered. Many people will have health insurance and not be able to afford to actually use it. A flexible spending card can help. Contribute at least your deductible to the account. You will pay a set amount each pay period towards your FSA. It comes out of your check before taxes. The entire amount that you have designated is available to you at the beginning of the year. You must continue to make the contributions for the entire year unless you change employers. In that event, if what you used exceeded what you had contributed you won’t be required to pay it back. I have a friend whose child received braces and shortly after he lost his job. The braces were covered by the FSA and he didn’t pay a dime; this was before they lowered what you may contribute to the FSA. If you have funds left at the end of the year or leave the company any leftover funds will be forfeited.
Know your network
Compare the costs of procedures at different facilities. If you are having a CT scan, MRI, myelogram, ultrasound or other tests, check to see which facilities are in-network near you. This is important for the dentist as well. Make some calls to compare the prices at different facilities for that test to find the best rate. Usually you are required to pay a percentage of the testing; the lower the fee for the test, the lower your out-of-pocket costs will be. For example: If a test is $10,000 and you have to pay 10 percent, your fee would be $1,000. If the test is $6,000 your fee will be $600 dollars. Check to see if the facility requires your payment up front or if they will allow you to make payments.
Sometimes a facility will require you to pay an estimated amount before services are rendered, and then they bill the insurance company. This can result in an overpayment by you — especially if you have already met your deductible. Always check your explanation of benefits to see what your insurance company paid and what it has determined to be your out-of-pocket costs. If you paid more than you should have, call the doctors office and ask for a refund. Don’t count on them just sending it to you; most times that won’t happen.
Don’t assume that because you went to an in-network facility for testing or a hospital stay that all of the doctors who see you will be in-network. Most of the time they are not. In this case, if you went to an in-network facility most insurance companies will treat the claim as an in network one. This results in the insurance company paying a higher percentage of the bill and reduces your costs. You still will be required to pay whatever the insurance doesn’t pay, but your cost will be lower. If you are required to pay 10 percent of a $1,000 dollar bill, your fee will be $100. If you are required to pay 20 percent because it is not in the network, you would be required to pay $200. Review the explanation of benefits and if you were billed for out-of-network services at an in-network facility, call the insurance company and request it to reprocess the claim. This has resulted in refunds for me in the past.