People today have so many choices when it comes to how, when, and where they receive health care. Options are great until they get overwhelming. How do you tap into those options and walk away a savvy healthcare consumer—someone who knows how to navigate your healthcare journey like a pro?  

Savvy health care consumers, we’ve got seven places to start.   

Understand your insurance coverage.  

It’s essential to know what’s included in your health plan—what’s covered and what’s not—as well as what doctors and treatment facilities are in your network. A survey of U.S. adults revealed that only 14 percent of them understood basic benefits terms including payments, coinsurance, maximum out-of-pocket spending and deductibles. When consumers think about the cost of health care, many factor in the monthly premium they pay for insurance, but that’s not the only cost. Copays and deductibles, as well as out-of-pocket maximums all need consideration. In addition, some treatment may not be covered by your insurance or may be considered out-of-network, which affects what you would owe for the treatment or service.  

Super savvy tip: If you need to see a specialist and are enrolled in an HMO plan, you’ll want to understand how the plan would cover the service and get a referral from your primary care physician.  As a patient, you are responsible for securing referrals from your primary physician prior to making an appointment to see a specialist. It’s important to make sure your insurer has received a referral before you make an appointment with a specialist. Only then will you know that your visit to the specialist will be covered under your health plan. PPO plans, however, do not require a referral.

 Take advantage of additional tools and services.  

Your health plan may offer member tools to help you get the most out of your coverage. Some helpful tools include:  

  • Personal assistance if you have an issue with an insurance claim 
  • Support to help you get health care faster, such as telemedicine  
  • Tools that help you compare treatment costs, such as cost estimators  
  • Decision support tools, like Decision Doc, which help you choose a health plan 

Review your plan to see if these services are available to you.  

Ask for pricing transparency.  

Before getting a procedure or other service, ask your health care provider about what price you can expect. Although the exact price will be different for each patient (usually depending on insurance coverage), every health care system has a list of charges for all the services it provides. It’s essentially the sticker price for a health care service. You won’t pay the sticker price due to your coverage, but knowing the amount gives you a ballpark estimate of what the service will cost.  

Super savvy tip: Decision Doc helps employees see how much they’ll spend on health care depending on what services they need. If your employer offers Decision Doc, try running different scenarios—with a surgery vs. without one—to get a straightforward view of potential costs. 

Shop around for services and get a second option when appropriate.  

Hospitals often charge more for services like laboratory testing and CT scans compared to outpatient clinics, so it pays to shop around for the best price. Outpatient diagnostic errors happen, so it never hurts to get a second opinion for major non-emergency surgery and checking the accuracy of your diagnosis. Before getting a second opinion, however, check to see if it’s covered by your plan. Remember, many insurance providers offer tools to estimate how much a service will cost with different healthcare providers.   

Review your health insurance bill after a procedure.  

Following a procedure, it’s good practice to login to your health insurance online platform and review the bill for the procedure and compare it with your claims to verify that the amount on your invoice reflects the amount your insurance company says you owe.  This will make sure you are being billed correctly. Ask for your bill to be itemized because an itemized bill contains detailed descriptions that can help you argue unfair or incorrect charges. 

Know where to go.  

Over 17 percent of ER visits are unnecessary, which adds up to about $4.4 billion in avoidable costs. Of course, when you’re in the middle of being extremely ill, it can be hard to know whether a trip to the emergency room is warranted. Often, in these situations, people panic and race to the emergency room. For more immediate or after-hours care, a trip to an urgent care clinic could be a great solution. Unless it’s a true emergency, urgent care may be a better use of a patient’s time and resources. Many of them are open seven days a week, have far shorter wait times than the emergency room, and cost less than a traditional hospital emergency room visit. 

Don’t skip preventive care.  

Insurers are required to cover most preventive care services in full. It’s important to stay up to date on your routine screenings because that is the best way to detect health problems before they become serious and expensive to treat. Preventive care includes immunizations, blood pressure and cholesterol screenings, obesity and Type 2 diabetes screenings, depression screening, colorectal cancer screening, prenatal care, mammograms, and others. Plus, preventive care doesn’t cost anything extra to you or your family. Download our preventive care handout!  

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