The best way to get the most out of your health plan is to know how it works and what you can expect from it. Be aware of the points below:
- Make sure you know what your doctors’ hours are and where you can get help when the chambers are closed. You may find a number of doctors who are willing to work with extended care facilities. These cost much less than an emergency room visit.
- Your doctor may be booked for appointment in advance. Ask your doctor how many days in advance you need to book the appointment for. Most of the doctors you see will have additional arrangement made for extra patients. However, it is always a better idea to plan in advance about what to do if your doctor is not available.
- Find out about what the radiology and lab facilities are at your doctor’s. Does he perform them at his office or do you have to go somewhere else? If you do, is it at a convenient location?
- Make sure you know whether your company provides a 24hour online advice service. Most companies will try to bring down the cost of treatment by maintaining a helpline that can advice patients when necessary. They will help you find out if you need to go for an emergency.
- Also find out what the specifications are for cover you receive outside your home state or the country. This is all the more important for you if you are a frequent traveler. Usually, the company will offer you a referral service for another doctor at the place you are visiting.
How to use your hospital benefits
You will find very specific guidelines for hospital care under your health insurance plan. Unless you are in an emergency, you primary care doctor will have to give you prior approval for you to be hospitalized. Here are some things you should keep in mind
- Find out the hospitals that are covered under your network. If you are receiving covers under an HMO plan, you will need to go through the primary care physician and your service may be confined to a single doctor only.
- Find out whether the hospital poses restrictions on the number of days you can stay at a hospital and still receive benefits. Who decides on your discharge, your doctor or someone else?
- If you need follow up care, will you need to get it at a health care facility or at home? Make sure you get adequate coverage for a treatment method of your choice. This is important incase you have a serious ailment and require full time services of a health care professional.
- Find out how the company handles second opinions. Will they accept second opinions of the doctor who is not a part of the network?
Urgent care during emergencies
When you are faced with an emergency, it is only right that you should go to the nearest hospital possible. Find out how the company defines an emergency and how you should arrange for ambulation services. Usually, an emergency is defined as a situation where you face a potential death. Most plans require that you should inform the company about the admission as soon as possible. If your emergency hospital is not a part of the network, you may be transferred to a network one once you are stable. Get details on how your plan handles such emergencies.
How does the company define urgent care that is usually needed after business hours? Ask for a list of conditions that the company deems as needing urgent care. The customer service hotline or your doctor’s answering machine may be able to guide you on what to do in these situations.