Along with celebration and a resolution or two, a new year means a refresh on your health insurance. Whether your employer has kept the same insurance or you recently participated in open enrollment on the state exchange for the first time, we encourage you to know your benefits and make the most of them.
Reviewing your health plan early in the year can help to financially plan for any upcoming medical services. Here are a few tips for balancing costs and ensuring you receive the best care:
- Which services are free?
Most health insurances fully cover an annual well visit for anyone on the plan. This is a free opportunity to talk to your pediatrician about any changes or concerns. Schedule your check-ups well in advance to have a better chance of getting a time that works for you. You may also consider keeping a list of questions for the doctor in the days prior to the visit. When making the appointment, feel free to ask if any vaccinations will be administered so you can prepare yourself and/or your child. Your insurance may require that each annual well visit is at least 365 days apart for it to be fully paid. Before you make an appointment, find out if your plan uses this rule, or if a well visit can be any time during the new calendar year.
- Know your copay costs and deductible.
What is your copay (the amount you pay up front) for a sick visit? Knowing this information before your child is feeling unwell will help avoid confusion at the check-in desk. Keep in mind that copays can vary for a sick visit to your pediatrician, a visit to a specialist such as an allergist or behavioral health professional, or a trip to urgent care. Generally speaking, primary care settings are the most cost-effective. Even the simplest of emergency room visits can cost hundreds of dollars. Unless your child is exhibiting serious symptoms, call your doctor’s office first to see if they can treat the problem. Insurance companies also closely track their members’ medical expenses to set premium costs and coverage limits in subsequent years. It’s also helpful to keep track of your deductible and out-of-pocket maximum. If you pay for services throughout the year and reach these amounts, you may be able to squeeze in additional in-network services at no cost at the end of the calendar year, such as allergy testing or a multi-month medication supply. Keep in mind that many employers only offer high deductible health plans in today’s expensive market, which keep your monthly premiums low but set your deductible high.
- Know your medication costs.
Even if you keep the same health insurance year to year, prescription costs may have changed. Find out what you can expect to pay for your daily prescriptions, and if you find that any medication is outside your budget, call your doctor’s office right away. They will work with you to get medicine you can afford. It’s much better to get a slightly different prescription than to not take a medication at all.
- Find out who is “In-Network.”
Insurance companies use networks of preferred physicians and facilities. Any time you get new insurance, or if you’re looking for a new plan, the first thing you should do is find out if your PCP is in-network and whether your doctor accepts that insurance. Usually, you can look up your network on your health plan’s web site and set up access to a subscriber portal. If your insurance has changed, you should also call your doctor’s office as soon as possible to provide updated information.
- When in doubt, ASK.
The back of your insurance card will include a member services phone number you can call with questions. Alternatively, many insurance companies provide a messaging function on their member web portals where you can ask non-urgent questions about your coverage. Always keep your insurance card with you as you never know when you might need it. You can also snap a picture of the card on your phone to use in a jam.
Understanding your insurance will make a big difference when someone in your family is in need of health services. Your ONE Pediatrics practice and physicians want you to receive the best and most efficient care, with as little headache as possible.
One Pediatrics is a medical group comprised of highly esteemed physician-owned private practices specializing in pediatric care in the Kentuckiana region. To date, there are seven affiliated groups with ten locations: All Star Pediatrics, East Louisville Pediatrics, Kaplan Barron Pediatrics, Oldham County Pediatrics, Prospect Pediatrics, South Louisville Pediatrics and Springs Pediatrics. We are the first in the Louisville area to achieve Level 3 Patient-Centered Medical Home designation. For more information about our growing medical group visit https://onepediatrics.com