Don't Be Hoodwinked by Your Insurance Plan

I had a very unpleasant experience with my insurance company recently which prompted me to write this post.  

I woke up one Saturday and was suffering from severe back pain.  I wasn't sure if I should go straight to the hospital or to an urgent care center.  My insurance plan says I can talk to registered nurse 24/7 if needed so I called one.  After going through a terrible automated phone system to identify myself, I finally reached a nurse who had me identify myself all over again while I was suffering excruciating pain. She finally determined I should go to an urgent care center.

Here's where the it got messy.  Because I have an HMO Plan, I only have in network benefits which means every doctor, every clinic, every hospital I go to must be in the network of my insurance company.  If I fail to do so, I will be responsible for 100 percent of the expenses.  I checked for urgent care centers in my area. There were 14 listed within 10 miles of my zip code.  I wrote down two addresses and called the first one, only to discover they were closed.  I figured the second one was good so I had my husband lock the address into his GPS and off we went.  The GPS took us to the Wal-Mart area and when we arrived at what we thought was the location we discovered it was an ABANDONED building.  I then looked up the center's phone number through my insurance company's website and called it.  Guess what?  The number was disconnected.  Now, how did that happen?  Who is responsible for checking to make sure the numbers and addresses are updated?  We then found another urgent care center not far and went to it---not knowing for sure if they are "in network."  But even if they aren't I will not be paying that bill because of this fiasco!

Here are some things you should know during your annual insurance enrollment period (or any time you sign up for insurance):

1) Be sure you understand how your plan works.  It may say it will pay 80/90/100 percent of eligible expenses but ONLY after you satisfy your deductible.  Make sure you are reading the fine print. 

2)  Check your deductible.  More and more plans are moving to higher deductibles which means you will have to pay out of pocket costs until you reach the deductible.  So, if you have a $5000 deductible, guess what that means?!

3)  Be sure you know what type of plan you have.  Is it an HMO or PPO?  An HMO plan (like mine) means you have only in network benefits and if you go outside of the network you will be responsible for paying the entire bill.  It also means you have to select a Primary Care Physician and that PCP is responsible for making ALL referrals.  If he/she doesn't refer you to someone in your Plan's network of Providers, you will both be penalized.

A PPO means you have both in and out of network benefits.  You don't have to declare a PCP and you don't need a referral to see a Specialist.  You may still need a referral in some cases so it's always best to check with your insurance company about that.

4)  Check to see if your plan requires any pre-authorizations for specific testing like MRI's or CT Scans or for some types of medical procedures.  Failure to do so will cost you dearly.

5)  Don't be afraid to ask questions about your plan  to your insurance company.  You'll save yourself headaches and some money if you take the time to get educated on exactly how your plan works.  

6)  Take advantage of any rewards/incentives the plan has to offer.  Some employers offer discounts on your premiums so find out what they are and sign up.

Don't let yourself get hoodwinked by your insurance plan because plans as we knew them 10 and 20 years ago have definitely changed---and it's not always for the better as I have discovered.