If the complexities of health insurance leave you scratching your head, you’re not alone. As doctors, we often find that many of our patients are unaware of some crucial aspects of their health insurance plans. So, we decided to compile a list of the top 10 things we wish our patients knew about health insurance. Let’s dive in!
- Preventive Services are Usually Covered: Many insurance plans cover preventive services like vaccinations and screenings. These can help detect potential health issues early, preventing more serious problems down the line.
- Not All Medications are Covered: Your insurance plan may not cover all medications. Before your doctor prescribes a new drug, check your plan’s formulary, a list of covered medications.
- You have a Network of Providers: Understanding your network is critical to avoiding out-of-pocket expenses. If you see a doctor out-of-network, you may have to foot the bill.
- Your Primary Care Physician is Your Ally: Your primary care doctor can guide you through the health system and coordinate your care, which can lead to better health outcomes.
- Emergency Room Visits Can Be Expensive: ER visits can come with hefty bills. Unless it’s a real emergency, consider going to an urgent care center or scheduling an appointment with your doctor.
- Referrals May Be Necessary: Some insurance plans require a referral from your primary care doctor before you see a specialist. Check with your insurer before making an appointment.
- Preauthorization is Often Required for Procedures: Many insurance plans require preauthorization for certain procedures. Always check with your insurer before scheduling a procedure.
- You May Have an Out-of-Pocket Maximum: This is the maximum you’ll have to pay for covered services in a plan year. Once you hit this limit, your insurance covers 100% of the cost for covered benefits.
- There are Free Mental Health Resources: Many plans cover mental health services. Don’t neglect your mental health; make use of the resources your insurance provides.
- Health Insurance has an Open Enrollment Period: You can only sign up for or change your health insurance plan during open enrollment, unless you qualify for a special enrollment period or you buy a private policy.
Understanding these aspects of health insurance can help you make the most of your coverage. Always remember, we, as your doctors, are here to help you navigate your way to better health!
