Insurance Webites

Did you know that with most insurance’s you can review your claims on their website?  I for instance have Anthem Blue Cross Select.  I found their website (the information is usually on the back of your insurance card) and signed up.  In order to sign up, you will need to have your insurance card handy and a valid email address.  Most websites will ask you questions and have you click the “I accept” disclaimer in order to join.  Once you’ve gone through the steps of setting up your account and password you would just log onto the website.  I recommend you save the website to your “favorites” so that it’s easy to find.  You will now be able to look at and print your claims.  There may be claims that say “processed, pending or rejected”.  You would just click on the one that you need and it will show the charges, what was allowed, what went towards the deductibles or co-pay, what the provider was paid, or what wasn’t paid and why.  Every member in your household will need their own sign in name, password and email to access claims.  

You can also find providers that are contracted with your insurance company.  But beware….just because they may be listed, doesn’t mean that they’re current.  If you find a provider that you want to see, call their office and double-check that they take your insurance.  Not all insurance companies keep their providers lists up to date, and providers may drop out of the plan, yet still show up on the website.

The website may also have information on wellness, health assessment, treatment- cost- advisor, compare facility cost and quality, your health record, a place to compare plan coverage options and a glossary/definition area as well.  These are very handy tools to have at your disposal.  There’s may even be a place where keep track of what money went towards your annual deductible and out-of-pocket expenses.  Not all insurance companies have the same information on their websites, but they’re great to utilize if they’re available and I would recommend that you start using it right away.

HMO's

HMO:  (Health Maintenance Organization) Health HMO’s are a form of Managed Care Organizations. The HMO agrees to provide health insurance coverage through hospitals, clinics, doctors and other providers with whom they have a contract, thus you are limited to providers that are contracted with your HMO plan. You must select a Primary Care Provider (PCP) who acts as the “gatekeeper” of your health needs.  He will be the first line of contact when you need to be seen or referred to a specialist or ancillary provider.  There are also “direct” referrals, which mean that he can give you an order for a service that does not need authorization or permission from your HMO.  This might be a lab test or simple x-ray.  Then there are the types of specialists or procedures that need “authorization” from your HMO.   When deciding to choose an HMO vs a PPO, make sure that the providers that you generally see are contracted with the HMO, otherwise you may have to establish relationships with a whole new set of medical providers.

COBRA Insurance Coverage

COBRA

Did you know that you may be able to continue your health insurance coverage in the event of a layoff?  If you meet the criteria, you and your currently covered family members may be eligible to purchase your insurance through COBRA coverage.  If you work for an insured employer group of 20 or more employees, Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986 that lets you continue to purchase health insurance for generally up to 18 months if you lose your job or your coverage is otherwise terminated, and in some instances may permit a beneficiary to receive a maximum of 36 months of coverage.  Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves. It is usually less expensive than individual health coverage though. 

ABN's (Non-covered service form)

ABN

Advance Beneficiary Notice of Non-coverage

There may be an instance when you want or need to have an exam or procedure that insurance will not cover.  In this case, the provider may have you sign an ABN (Advance Beneficiary Notice of Non-coverage), which states that you may be responsible for the charges in the event your insurance company does not pay the charges.  An example of a non-covered service would be fertility testing.  Most insurance companies will not pay for any fertility testing and your provider may have you sign an ABN before any fertility examinations or procedures are performed.  You can ask your provider if they will discount your bill to “insurance rates”, (what your insurance would pay them if it were a covered benefit), but chances are they will ask you for the full payment up front when you come in to have the service.  You can also ask them to bill your insurance company, but chances are your insurance company will deny payment.