Dallas County Living Well Magazine May/June 2916 | Page 14

Need to Avoid Big Medical Bills?
7 Steps to take Before Visiting Your Doctor

M

any 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?
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.
12

DALLAS COUNTY Living Well Magazine | MAY/JUNE 2016

By Key-Whitman Eye Center

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 long-standing 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 BEFORE 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.
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.