Tips and Suggestions
- Insurance Carrier Website Registration
- It is very important to stay informed and to know what is going on with your insurance. Getting registered as a member with your insurance carrier website is highly recommended. The process is simple. As a member, you will be able to track your EOBs (Explanation of Benefits), obtain important cost control information, and much more!
- The Emergency Room vs. Urgent Care Clinics vs. Walk-In Clinics
- With most health plans, you have MANY options with regards to when and where to get treatment. If you have a life threatening emergency, please seek immediate medical care at the closest emergency room or call 911 for immediate attention. Anything short of a life threatening emergency, it is recommended that you think twice before immediately going to the emergency room…you have other options which will save you a lot of time and money.
Walk-In Clinics: There are many walk-in clinics within certain HEB grocery stores, Walgreens, etc. that you can use for non-emergency care without an appointment and without waiting. There are many locations in most areas that are in-network and care can be obtained with your co-pay. This is an excellent option for common illnesses such as the flu, strep throat, colds, ear infections, etc. Locate in-network facilities in advance so that when you need care, you will know exactly where to go.
Urgent Care: Urgent care facilities are excellent places to get care and the copayment through your medical plan is a lot less than the copayment for the emergency room. In addition, the time it will take to get care will be substantially less when compared to an emergency room. Most urgent care centers will treat everything from cuts requiring stitches, x-rays for potential broken bones, and non-life threatening illnesses. It is important to go to an urgent care provider that is in your network so locate some facilities in advance that are near your home and place of employment. When faced with a situation requiring medical care, you will know exactly where to go.
- In-Network vs. Out-of-Network (Do’s and Don’ts)
- Although you may have coverage for care received by out-of-network providers, it is CRITICAL to do everything possible to always obtain care and treatment from in-network providers. The cost to both you and the plan will be substantially less when you stay in-network. Be proactive and locate in-network providers well in advance of needing care. If you need to locate a network provider, you can go online to the carrier website or you can call the insurance carrier directly. Please note…do NOT call the provider’s office and ask “if they accept” your insurance. The provider will always answer “yes” to this question but that does NOT guarantee they are in your network of providers. This answer simply means they will accept the insurance and will bill the carrier on your behalf but if they are out-of-network, you will be responsible for a lot more money. Once this happens, you will not have any recourse with the insurance carrier or the provider’s office. The best plan of action is to avoid this situation by being proactive and making 100% sure the provider is in the approved network associated with your plan. The bottom line is that obtaining care from an out-of-network provider will cost you substantially more money when compared to an in-network provider.
- Ask Questions (Lots of Questions)
- Many people have the tendency to be intimidated when talking to or dealing with a physician and/or the staff at a medical office. Do not let this be you! You are the consumer and “customer” and it is your health that you are dealing with. You have every right to ask questions and know exactly what is being recommended and why. If you are not comfortable with the answer you receive, seek a second or even a third opinion. If you are told that you need treatment or testing, ask questions and make sure you are very clear on why it is being recommended as well as what alternate care options are available. This holds true when dealing with the front desk or billing department at the provider’s office as well. If you are told to pay an amount that does not match your understanding of the benefits, ask questions. If you are certain the amount being requested is wrong, call the insurance company while you are at the provider’s office, and confirm the amount. Although the provider’s office deals with insurance carriers every day, they make mistakes. Be an informed consumer and understand your insurance benefits so that when this situation occurs you already know how to handle it. Be proactive, understand your benefits, ask questions, and make sure you are clear and in agreement with whatever billed amounts and treatment plan is suggested for you and/or your family.
- Prescription Drugs
- There are many ways to save money when it comes to prescription drugs. Here are a few suggestions:
Samples: If your prescription is not a maintenance medication (something you will be taking for longer than 30 days), ask your physician for samples. Many times your physician will give you enough samples to eliminate the need for getting a prescription filled and paying your copay. Asking for samples is also recommended when you are being asked to take a medication for the first time. It is best to use samples to see if the medication will work for you and you do not experience any adverse side effects before getting the prescription filled and paying the required copay.
Manufacturer Coupon or Rebate: Another way to save money on higher priced prescriptions is to ask your physician for a manufacturer coupon or rebate card. These exist for a lot of different medications and can be obtained by simply asking. If the physician does not have any, go to the manufacturer’s website or the website for the specific medication and see if one is available online. Simply asking a question and/or doing a little research may save you some money.
Generic: In most cases, using a generic medication will save you money over a name brand medication. In fact, some insurance carriers are starting to require the use of generic medications when they are available. When given a prescription, ask your physician about the generic options. Also, when you are getting a generic prescription filled, there are many generic medications that are priced below your copay so ask the pharmacist what the “cash price” would be and if that is lower than your copay, make sure you pay the lower amount.
Mail-Order: If you are taking a maintenance medication (a medication you take on a
Consistent basis for 90+ days), taking advantage of the mail order prescription program can save you both time and money. With some plan, you can get a 90 day prescription and pay just two copays. To start this process, you must first obtain a 90 day prescription from your provider and then follow the instructions required by your health plan.
- Dental Care
- It is proven that the lack of dental care and treatment leads to medical related health issues.
Regardless of whether or not you are covered under a dental plan, get your teeth cleaned every six (6) months. This is a very simple thing everyone can do to improve their health and help eliminate medically related issues from occurring. Do not discount this statement, this is a proven fact and over the long term being proactive in this area will potentially save you a significant amount of money on healthcare related services.
- Supplemental Insurance
- Do you take advantage of the supplemental insurance options that are available to you? If not, this is highly recommended. With all medical insurance plans, there are out-of-pocket expenses that are not covered. For example, there are copays, deductibles, coinsurance, and for catastrophic health conditions; certain things like travel cost, experimental treatments, loss of income, etc. Supplemental insurance options are designed to put money in your pocket, based on medical events taking place, to help protect you and your family against out of pocket expenses. There are many supplemental plans to choose from so you have the ability to customize your benefits plan and create a well-rounded and personalized level of coverage specifically for your situation and your family.
Disclaimer – The questions and answers listed are very general. There are many different plans and options available when it comes to health insurance so please review your specific plan information. Both you and your employer invest a lot of money in your employee benefits program. Controlling cost is a team effort. The higher the claims, the more your insurance cost can increase each year which means more out-of-pocket cost for you. Listed below are some tips and suggestions that will help you get the most out of your benefits in a financially responsible manner.