7 Steps to take Before Visiting Your Doctor
Need to Avoid Big Medical Bills ?
7 Steps to take Before Visiting Your Doctor
By Key-Whitman Eye Center
Many patients are confronting colossal medical expenses and are confused by their health insurance coverage . So what can you do to guarantee you have health insurance coverage ?
1 . Know that you should advocate for yourself . When you think of the term ‘ patient advocate ,’ most people assume the insurance company or doctor is playing that role . However , in today ’ s insurance environment , things have changed . Now the patient needs to advocate for themselves . “ What we find now is , what the patient says and asks for , usually matters more than anything else ,” says Dr . Whitman .
2 . Utilize the resources at your insurance agency for help . Most insurance agencies have individuals on staff to assist you and help make sense of your policy and what doctors and specialists you can see . These individuals are commonly called a patient advocate , patient navigator or customer advocate . They can assist you with finding a physician who is in-network or requesting approval to see an outof-network doctor .
3 . Read your insurance card and policy very carefully . When you receive your new insurance card each year , immediately compare your old one to the new one to see if anything has changed . Has your coverage changed from a PPO to an HMO ? Are referrals required to see a specialist ? Have co-pays increased ?
4 . Don ’ t automatically think your insurance coverage hasn ’ t changed . Even if you haven ’ t requested changes to your policy , your coverage may have changed . As insurance agencies explore the new scene advancing under the ACA – or ObamaCare – many need to make changes to their plans and provider lists .
5 . Make a point to select a primary care physician ( PCP ) who meets your needs . Should you not select a PCP ( i . e ., a family practitioner or internist ), your insurance company will assign one to you on your behalf . Many insurance plans have a limited network of providers you can see , and not all PCPs can refer you to the specialists you prefer .
6 . Realize that you may need to see your PCP in person , before they can give you a referral to see a specialist . According to Key-Whitman Director of Patient Accounting Matt Chapman , “ If you ’ ve had a longstanding appointment with your specialist ( i . e ., ophthalmologist , glaucoma specialist , immunologist , cardiologist , diabetes specialist , etc .), and your insurance policy changed in the meantime , contact your insurer BE- FORE you head to the specialist ’ s office . ( Keep in mind , the insurer ’ s list of in-network providers can change at anytime .)”. If you ’ re a Key-Whitman patient , our insurance navigators will ask you a series of questions to determine what services your insurance covers here .
After reviewing your new insurance card , check your insurance policy . Compare last year ’ s plan to your new plan . Check for changes to :
• Deductibles .
• Co-pays for doctor visits , emergency services , etc .
• Preventive services covered .
• Prescription drugs covered and co-pays .
• Maximum out-of-pocket expenses .
• Referral requirements .
• Doctors and specialists included in the insurer ’ s network .
• Coverage for using healthcare providers in and out of network .
7 . Consider selecting healthcare providers that cover a more expansive territory . “ When picking a specialist , it ’ s usually important to find one that has a large geographic presence . For example , Key-Whitman has locations all over the metroplex . We have ophthalmologists , eye surgeons and optometrists in Arlington , Dallas , N . Dallas , Mesquite , Plano and Richardson . That avails us to getting into more insurance plans , which means you ’ ll have an easier time navigating those insurance waters and getting to our most convenient office for the best eye care possible ,” says Dr . Whitman .
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COLLIN COUNTY Living Well Magazine | MAY / JUNE 2016