Understanding Your Health Insurance

Many people think that because they have insurance their medical expenses “are covered.” This is not always the case. A better understanding of your health insurance policy and Patient’s Rights will give you more control over the out of pocket medical costs that you incur.

This one-on-one service is an invaluable tool designed to help you better understand how your health insurance coverage and benefits work. The tutorial can be conducted in our Boca Raton office, by telephone or by Skype; whichever is more convenient for you. Together, we will review various aspects of your insurance policy. This will increase knowledge of how your health insurance coverage operates- resulting in a savings of time, money, and frustration. This valuable service is an excellent way to educate and protect yourself in the confusing and expensive world of medical services and the health insurance industry.

In-Network vs. Out-of-Network Services

We explain the great difference in cost to you depending upon your usage of in-network vs. out-of-network, physicians, labs, diagnostic facilities, urgent care facilities, pharmacies, and hospitals. You will be shown how to make the most cost-efficient choices regarding medical provider options— resulting in avoiding drastically higher medical bills. Using an out-of-network provider can cost you hundreds or even thousands of dollars—money that you did not need to spend. Knowledge is power. We help pass on a better understanding of this very important aspect of your health insurance coverage.

Pre-Authorization

We address the requirement of “pre-authorization” contained in your insurance policy. Each insurance company requires pre-authorization to be obtained prior to undergoing different medical procedures. Although your physician’s office and testing/surgical facility usually work together effectively and obtain the pre-authorization, there are times when there is a breakdown in communication. We will address what you can do to avoid hefty charges that could occur in such circumstances. Failure to follow your insurance company’s rules may result in greater expense or denial of coverage. Our tutorial can help avoid that as well as reduce the inconvenience of postponing or rescheduling procedures.

Drug Formulary

Understanding your insurance company’s drug formulary may help avoid delays in or denials of access to your prescriptions. Many people do not even know what a drug formulary is, let alone the fact that their prescriptions are governed by its contents. Sometimes, insurers completely deny coverage for certain drugs prescribed by your doctor. Patients can be without their medication for weeks – getting the runaround from their insurance companies. Prescription costs can vary dramatically. Understanding the operation of your insurance policy’s drug formulary and working with your doctors can reduce delays obtaining the medicines you need, as well as save you considerable amounts of money.

APHA
Certified Patient Advocate
Greater National Advocates
NAHAC