Insurance 101

When I worked at IHC and at Educators I was amazed at how little people know about insurance so here is some helpful advice to all of you out there who think that insurance is of the devil.

• Please, please, please make sure that you add you new addition to your insurance ASAP. In fact, call from the hospital and get them added. When I was at IHC you would be surprised at how many people forget to add their baby. If you do not add your baby have the possibility of not having coverage for that new baby after the 30 days. So to avoid unwanted bills please ADD YOUR BABY!
• Know your policy! Know what is covered and at what percentage. Know how many visits you can get for Physical Therapy and if you have a copay. Know what your Emergency Room copay visit is and if you have an insta-care or after hours copay and if the copays are higher than your regular office visit. Find out if what your percentage of responsibility is. Also, find out what things are excluded from your policy. For example sometimes speech therapy is not covered if it is not related to medical diagnosis (i.e. your child has a slight speech problem is usually not covered under speech therapy). Most plastic surgery is not covered so you need to find out what is covered (most insurances will not cover breast augmentation or breast deductions but they are required under the Women's Cancer act to pay for some breast surgery in relation to breast cancer so find out!). Lasik Eye surgery is usually not covered but insurance will pay for cataract surgery.
• Remember that everything is based on the diagnosis codes and procedure codes that the doctors bill with. If you receive a bill that you don't think is correct then you will need to contact the doctor and have them review what happened. For instance a code submitted for cervical cancer is only covered on females and not covered on males. There was one time when the patient was a male but a OBGYN ordered some work done. Of course this is going to be questioned as to why this male was needing an OBGYN. So make sure that what is being billed is what was done and ask questions regarding the bill if you have them.
• When you have a child there are many different doctors involved so you will have many different bills. You will have the OBGYN bill for the 9 months that you saw them. You will have the hospital bill, you will have the anesthesiologist bill for the epidural, if you have a c-section you will have a surgeon bill if your doctor does not perform the c-section. Don't be alarmed when you see different statements when you have a baby.
• If you have a network you are suppose to use....USE IT!!! It will save you money. The doctors that are in your network have to follow certain guidelines in order to accept that insurance. Most of them must bill for you because they are usually required to submit billing a certain way and all of them have to accept the amount that the insurance pays for the services. If you do not use your network you usually have to pay a lower percentage and you can be billed for anything that the insurance does not cover.
• NEVER pay your deductible up front. If you go to the clinic and they say that you have a $300 ded that you have to pay inform the clinic that you will wait until you receive your explanation of benefits to find out who you pay that deductible to. You may have already reached that deductible with another doctor that the clinic may not know about. Or if you had a baby you may have to pay the anesthesiologist the money and not the hospital. The deductible will always apply to the first bill that is submitted until the deductible is met and nobody knows what claims have been received and when. My rule of thumb is to never pay the doctor any more than your copay. If you are required to pay a percentage, never pay that percentage until after you have received your EOB from your insurance.

I think that kids graduating from High School should be required to take a class on Insurance or take a life skills class that includes things such as setting up a budget, learning about insurance, and other things that they will be facing once they are in college. I know most of them take a class like this in 9th grade, but I think it should be required to take the last semester of school so that it is fresh in their mind before heading off to school. Many students don't know what to do when they get sick or how to deal with doctors and insurances until it is too late. I also think that they need to be informed about how important insurance is. Most kids these days look at insurance as a an additional deduction in their paycheck and opt not to receive it because then they can keep that money as their own. But take it from someone that knows, you NEVER know when you are going to need that insurance! I did not know when I had my second child that he would have a life threatening medical condition that would require thousands of dollars spent on him every month. Some people to opt for the insurance and then when they need it, it is no longer available to them for a time. So take advantage of the benefit NOW.