Claims and Financial Help
As agents, we can help you with understand the claims process. We can also help you check for financial help to help pay premiums or out of pocket expenses. Most people with health insurance, Medicare, or Medicaid have free preventive health care services, and copays for many commonly used outpatient services like a doctor visit, or generic prescription. For diagnostic care, hospital and emergency treatment, members on most plans will have out of pocket expenses that may include a deductible, or coinsurance. When your cost sharing comes due for more expensive care like major diagnostics, or hospital care, be sure to check for fair member pricing, and check for financial help. There are ways to estimate your costs in advance of services, and there are ways to get financial help, if you qualify. Below are some ideas that may help you save money with premium, or out of pocket expenses;
- Understand how your benefit programs work and read your benefit summaries
- Use Preferred Providers whenever possible
- Use Preferred "National Providers" when out of your carriers immediate service area. Check for health plan national networks here
- Make sure all providers have your complete current insurance carrier information
- Check your bills carefully, and review all of your Explanation of Benefit reports
- Check for financial assistance before pay hospital bills, and before you make payment arrangements. If you are within 200% of the federal poverty level, hospitals may write-off your medical bills as charity care. If you are within 300% of the federal poverty level, then hospitals may help with some of your medical bills. Calculate your % of fpl here
- Negotiate final bills directly with hospitals, providers and diagnostic providers whenever possible
- Check for eligibility for the Advanced Premium Tax Credit here
- Employers may be eligible for the Small Business Health Care Tax Credit. Check here
- Payment arrangements are usually available. Try all financial assistance options first. If you make payment arrangements, and then find out later that you may have qualified for relief, you may be asked to stay with your original payment arrangement.
- Understand the appeal process. If you find charges greater than what you see on www.healthcarebluebook.com, then you can inquire at the plan
- Keep your paperwork together and take notes. Write down the names of the people you talk with and their phone numbers.
- Do not delay responding to medical bills, because medical providers will send bills to collections. Additional relief may be available due to the virus.
- Make sure to get pre-determination for medical or dental treatments whenever possible
- Discuss scheduled surgeries or complex medical treatments with your insurance carrier prior to service
- Healthcare BlueBook. This site provides the approximate member cost for in-network services
- Health Savings Account Health Plans allow consumers to pay for qualified medical expenses tax-free. Read more here
- Contact your agent if you need assistance