Looking at common complaints about health insurance, it is clear that many of them can be avoided by taking small steps into learning the jargon and understanding how insurance coverage works.
For some people, there are not many options when it comes to health insurance simply because they take whatever their employers provide. But for others, they either shop for their individual health insurance or choose one of multiple plans available through the employer. When it comes to make your pick, there are many items that you must keep in mind to ensure that the coverage you’re getting is the right one for your individual needs, age and health requirements.
Here are some points to keep in mind if you’re selecting health coverage.
Your health
This is a big factor in what plan you should choose. Are you a healthy young person who rarely has to see a doctor? Or are you someone with existing conditions and ongoing prescription medications? Based on how much you expect your insurance to cover, you can make your mind about how much insurance you want to buy. For example, paying for low copay for office visits and medication may not be justified if you’re healthy. In such a case, you may be able to pay a lower monthly premium by increasing your responsibility for office visits, copay and out of pocket.
Jargon
Insurance terms such as deductible, copay, premium and so on could be confusing for people who are not used to them. If you’re not sure what a term refers to, ask questions. These are all critical points that you will have to deal with once you make a claim. If you confuse them, you may find yourself responsible for more than you expect or afford.
In addition, once you understand how one of these parameters work, you will be able to easily navigate the plans and pick the one that fits you best without being bogged down with details that don’t really matter. For example, if you typically struggle with cash flow, a high-deductible plan may not be a good choice for you. You may prefer to have coverage that requires a slightly higher monthly payment, and a lower deductible.
Insurance company
Your health coverage is only as good as your insurance company. What you really need is a provider who is responsive when you make a claim, available to answer questions when you are tight on time, and with a good network of physicians. All of this should be discovered as early as possible and before you purchase the coverage.
To get a good idea of your future insurance company, look for reviews online and check the network of providers. A little bit of research can help you find out whether the insurance company is known for paying off claims, reliable in terms of processing claims and following up on your questions and needs.
Get approvals
Regardless of how far you understand your coverage and your exclusions, always get approvals for major medical procedures and tests. Don’t just rely on the doctor’s office checking for you, because at the end of the day, it is your responsibility to take care of the expenses regardless of your misunderstanding. That is why, you always must do your best to confirm not only that a certain procedure, lab work or medication is covered, but also to what extent.
In addition, clarify if there are any conditions for the coverage. Some insurance companies may require a certain period to lapse before certain coverage — such as maternity — is provided. With that in mind, your role is to refer to the written plan, call and ask questions and double check with your provider to make sure that your understanding matches what they have on the record for you. Don’t overlook any misunderstanding at this stage because even the tiniest detail can prove very costly down the road.
The writer, a former Gulf News Business Features Editor, is a Seattle-based editor.
