Fall 2015: Health Insurance 101 for All Insureds

Fall, 2015
By Sandra Henderson, Vice President, Insurance

Most of us know the drill. We get sick or injured, head to the doctor or other healthcare provider; they get our insurance information and then bill the insurer for our treatment. You then get a bill from your doctor and an Explanation of Benefits (EOB) from the insurance company. This is where I say, BE WATCHFUL! Confusion can be a breeding ground for mistakes.

Here’s my recommendation in dealing with this confusion, specifically with claims:

  • Never pay a bill to a provider before you get your EOB from the insurance company. Lots of times the doctors send out bills before insurance benefits have even been considered.
  • If the information between the provider’s bill and EOB don’t match, find out why!
  • Try to have at least an idea on what your benefits should look like for whatever procedure or care you have had done. All insurance companies provide personal online connections to your health insurance plan. You have to sign up for it, but it makes it very convenient to check your benefits and your claims. Then if that doesn’t look or sound right, you have the option of calling the insurance company direct (customer service number on your health insurance card) or call our office and ask us to help you out. That’s what we are here for!
  • If a claim payment doesn’t seem quite right, don’t assume it is. There are humans entering these claims, mistakes can be made. When in doubt, ASK!
  • It’s wise to shop around for hospitals, labs, etc. to find the best rates for whatever procedure you are having done. This really comes into play when you have a high deductible plan and much of the health care cost will be coming out of your own pocket (keeping in mind of course that you’ll always come out better using a preferred provider, but there is usually more than one and that’s where you can make a choice).

Generally speaking, most of you don’t pay that much attention to benefits until you need to use them, and that’s where we come in; we’ve got your back!

Turning 65 this year? Please remember to give us a call.

You will most likely save by going to a Medicare Supplement plan as well as enjoy much richer benefits by switching to Medicare and filling the gaps with a Supplement plan. If you are currently under a group plan, it’s best to compare the costs and benefits; usually a Medicare plan comes out better.

Someone need an Individual Plan?

Just a reminder that open enrollment for individual plans won’t begin until November 15th. At that point you will be able to change your plan to be effective as of January 1st. If you have lost coverage due to no fault of your own, i.e. lost your job and along with it your health insurance, you qualify to apply for individual coverage without waiting. You only have a 60 day window of time (from when you lost your coverage) to complete the process or you would have to wait for open enrollment.

Consult an accountant or attorney for advice on how insurance strategies apply to your own personal situation. This material contains the current opinions of the author but not necessarily those of Plan Financial and such opinions are subject to change without notice. This material is distributed for informational purposes only. PFI Insurance Services, a licensed insurance agency and division of Plan Financial, provides clients with access to insurance issued by leading insurance companies. Insurance products are underwritten and issued by participating insurance companies. This is not an offer or solicitation in any jurisdiction where the policies are not approved for sale. Any obligations under the policies are the exclusive obligations of the insurance companies and are subject to the financial conditions of the insurance companies. Information contained herein has been obtained from sources believed to be reliable, but not guaranteed. No part of this article may be reproduced in any form, or referred to in any other publication, without express written permission. Plan Financial is a trademark or a registered trademark of Plan Life & Wealth Management, Inc., in the United States.© 2015, Plan Financial.

Print Insurance Insights Fall 2015