September 15, 2008
Check It Out!
Get to know your health care coverage plan before you have to use it
by Joan Carr, Director of Revenue Management
As we all know, healthcare costs continue to rise. Healthcare in this country is primarily employer-based, with the exception of TriCare, VA, Medicare and Medicaid. Since employers struggle with corporate budgets like we struggle with our personal budgets, it makes sense for employers to look for the best rate on health insurance coverage.
Managed care plans (HMOs, PPOs, and EPOs) have cost containment features built in them; and some of these pertain to ‘in-network' or ‘out-of-network' status. A ‘network' is usually a specific geographical area, a specific group of providers and is sometimes both. Even Medicaid plans (all are specific to the state in which they operate) can differ in coverage rules. Some insurance plans have reciprocal agreements (they honor each other's coverage guidelines); some do not.
It is important that before you travel out of state and especially when you are relocating to another state, to know what your insurance will and will not pay for in case of an illness. If you are being treated under worker's comp insurance, it is especially crucial since some workers' comp companies change their reimbursement rules when the patient moves outside the coverage area.
You may want to check out options for temporary health insurance coverage when traveling. Usually travel agents or your own insurance agent may be a resource to you for this. You may have to research the hospitals and providers in the location you are traveling or moving to. The local better business bureaus and the local medical societies can also provide information. Your own health insurance plan's customer service department may also be a resource.
The point to all of this is that you do not want to be uninformed in times of an emergency. All insurance plans have different rules for different care settings as well. Your insurance, for example, may cover you for treatment at an out-of-state hospital, but not provide for treatment in an out-of-state physician's office. You need to understand these rules so you can plan effectively and make informed decisions if the need arises.
If you are traveling outside the country, this becomes critical; just as critical is updating all of your emergency contact information and your medications list. Ensure that any allergies you might have are also on the list. In the event that you are unconscious and being treated by emergency medical personnel, they would need to know whether or not you are allergic to anything on the drug protocol they are using for your condition. This also applies to travel by ship or train.
If you have coverage by multiple insurance plans, keep in mind that you will probably be dealing with coverage rules for each plan in addition to the order in which they pay (primary, secondary, etc.). For example, if your primary coverage only covers you in Alaska but your secondary coverage (like Blue Cross or United) has reciprocal agreements that are nationwide, your secondary insurance could become the primary payer in this situation. Once again, you insurance plans' can be a resource to you in making these determinations.
One other thing, if you find yourself in situation where you have no choice but to pay cash, note that most providers will give a cash discount to any patient who pays at the time of service. These discounts are usually between five and 20 percent. They do not give discounts if they have to bill you. Also note that most providers take Mastercard and Visa.
Once again, we see that understanding health insurance coverage is not easy at times, but it is better to have this understanding before you are faced with an emergency, so check it out!
Thank you for the responses to these articles. If you have a topic that you think would be of interest for our readers, please call 543-6398 and let Joan Carr know your thoughts.
