How to Control Your Medical Costs

By Floria, Barbara

The health care decisions you make have a big impact on your life and your wallet. To get the best value for your health care dollar, the first step is to understand your plan.

Health plans offered by employers generally come in one of three types, according to the Patient Advocate Foundation:

  • Fully funded/fully insured. This is a group plan contracted with an insurance company and paid for by employees' premiums. Coverage is governed by what the insurance company offers.

  • Self funded with third party. This is a health plan offered by employers who pay their own health care claims but contract with an insurance company to manage the benefits. Employees' premiums are used for the claims. Coverage is determined by the employer or by what the insurance company offers.

  • Self insured. This is a health plan offered by employers who process and pay the health care claims. Employees' premiums are used for the claims. Coverage is determined by the employer.

Your health plan

Health insurance plans are complicated, but the more you know about your plan, the more cost-effectively you can use it. If you have questions, contact your health plan administrator or benefits coordinator.

  • Know your benefits. Reading your plan and any updates as they arrive can help you be aware of which services are covered and the limitations, exclusions and maximum payments. Choose a protection level that meets, but doesn't exceed, what you and your family need. If a benefit you want is not covered by the plan, talk to your employer about adding that benefit. In many cases, if an employer wants to cover a benefit, the health insurance plan can be modified to include it.

  • Learn how much you have to pay. Health plans typically ask you to pay a portion of the benefit cost, in the form of deductibles, co-payments or flat fees. Use benefits wisely to save on out-of-pocket expenses.

  • Learn how to get coverage. Follow your plan's guidelines for getting referrals to specialists, being admitted to a hospital, getting a second opinion or having a screening test.

  • Know whom to call. You should know whom to call to learn about benefits, ask billing questions, resolve a problem, get a referral or find advice on prevention.

Your doctor

Most of your health care costs begin with your doctor. Communicating with your doctor about your care ensures you get the right treatment without paying for extra tests or medications you don't need.

  • Learn whom to call. Can you ask a nurse or doctor routine questions over the phone, or must you make an appointment? Can you get a prescription over the phone?

  • Use self-care wisely. Before you call the doctor, call a nurse advice line or use any similar option your health plan may offer. Self-treat colds, stomachaches and other minor ills.

  • Prepare for office visits. Be sure to give your doctor all the information needed to make a diagnosis. This includes your medical records, family medical history and a list of the medications you take. Bring along a list of questions you want to discuss.

  • Learn all you can about your condition and treatment options. You can get information from books, your doctor, medical associations and online. Understanding your condition will help you make better health care choices.

  • Ask about less costly treatments. For example, if your doctor prescribes a brand-name medication, ask if a generic medication would work as well.

  • Follow through. When you agree to a treatment plan, take medications as directed and keep up with any disease management and prevention steps your doctor recommends.

  • Know what to do if a claim is denied. Most plans must tell you within 90 days if a claim has been denied. Know the procedures to follow if you want to seek reversal of a denied claim.

Extended coverage

If you lose your job or quit, you may be able to continue your current health insurance for a limited time. This extended coverage is called COBRA, for the federal law that authorizes it. You will have to pay for the coverage, but it allows you stay with your current plan until you can get a new policy. Continued coverage is important, because some chronic conditions such as diabetes may not be immediately covered by your next health insurance policy if the current plan lapses.

Medical Reviewer: [Foster, Sara M. RN, MPH, Godsey, Cynthia M.S., M.S.N., APRN, Lambert, J.G. M.D.] Last Annual Review Date: 2008-04-17T00:00:00-06:00 Copyright: Copyright Health Ink & Vitality Communications

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