Now I have insurance... what do I do with it?!

Since the implementation of ObamaCare, talk of insurance has increased dramatically. Many people are "forced" to have insurance who have never had it before. It can be a very confusing time and I totally understand!





What do I do with it?! How do I use it?

As long as your monthly premium is being paid (by you or your employer) then you will have coverage. Each plan has different kinds of coverage with different amounts of copays, deductibles, and coinsurances. Just because you and your friend both have BCBS, it doesn't mean your plans are anywhere near similar. So make sure you have an idea of what is included in YOUR coverage. Some plans will not cover dental or optical, some will. Some might only cover a yearly eye check and that's it for optical and others may cover hardware too or nothing at all.

If you are seeing a specialist or having a procedure, they may call you a few days before your appointment and get your coverage info so they can do the necessary steps to make sure you will be covered. Many insurances, mine included need a Prior Authorization before you can do anything out of the ordinary (regular outpatient doctors visit is considered ordinary. Colonoscopy is not considered ordinary and would need a Prior Authorization).

A Prior Authorization is basically asking for permission/ coverage for a certain procedure. Most doctors offices will obtain this for you when they make a referral (or the office being referred to will for you). They want to be paid and they know you don't want to pay it unless you absolutely have to. They will even fight for a Prior Authorization if your insurance is being difficult. They know the ins and outs of this. If you do not obtain a Prior Auth. and your insurance wanted you to, they MAY NOT cover anything on that visit/ procedure.

When a clinic gets your insurance information, they will check your coverage for you (or at least they should). They want to know that it's active and that they will get paid. It helps cut down costs if they know you have coverage and they don't have to chase you down for money (think postage, envelope and personnel costs to follow up, and collection agency costs) .

I do this every day for every patient we see. In my particular facility I HAVE to or we may not see any payment on that visit at all.

This is what I see when I look up plans. This particular picture is from BCBS coverage.
I can also see when coverage started, when it's ended (if there is an end date) and group number info. 

Here's another example:

This is what I see when I look up Montana Medicaid. This person does not have any co-pay/ coinsurance.
Also shown is that they have full coverage, the date it started, and ending (though MT MCD only works one month at a time. It won't actually end on that date but it COULD so they only approve one month at a time.). 

If you have any questions about your coverage, ask the person at the front desk- they can point you in the direction of someone who can walk you through it. I'm sure every clinic has someone who knows something about insurance ;). 

The trick with checking for coverage is it's always an estimate on how much they will cover. No one, not even your insurance company, can guarantee exactly what they will pay/ allow for a service until it is processed. They can give you a pretty good estimate though and that's usually what clinics work off of when they let you know "roughly" how much a visit will cost you. 

When you check in for your visit, they should have you sign someone called an "Informed Consent." What this is, is basically approving that they can bill your insurance. Each place you see that is going to bill your insurance should have you sign one of these. If not, TECHNICALLY it's illegal for them to bill your insurance because they will be sending your insurance company Protected Health Information (PHI) and that's a big NO-NO (think HIPAA!). 

Informed Consent comes in many different ways. It doesn't have to be a form titled "Informed Consent" but basically somewhere it should say that you approve that they can send your PHI to your insurance for billing purposes. Here's an example of what ours looks like:

I hope that any place you are seen at has you sign at least one thing while you are there, each and every time you are there. 

A few weeks after you are seen by your doctor, you should receive a letter in the mail called an Explanation of Benefits (EOB). An EOB is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. I will get more in detail on all of this in another post. Once you receive an EOB, that means your visit (claim) has been processed and included in it should be how much, if any, you need to pay your doctor. 

Check back later to see more info on EOBs and how they effect your pocket!