Making the Most of Your Benefits

January 1, 2020
Making the Most of Your Benefits

Healthcare can be confusing — and costly. Here are some ways you can make the most of your health insurance benefits. Master these points to stay healthy and save on your healthcare costs!

Stay In-Network

Your benefits will be paid at a lower rate if the doctor or other healthcare provider is not in your network. Make sure all doctors and other experts involved in your care are in your specific network. This means specialists (such as anesthesiologists), medical equipment and lab or X-ray testing. Out-of-network care will cost you more.

Using a QualChoice National Network (QCNN) provider for emergency services when traveling will help limit your out-of-pocket costs. For a list of QCNN healthcare providers, call the toll-free number on your ID card. If your health issue is not an emergency, care at an ER will not be covered.

Get Pre-authorization, if Needed

To be covered, some services require pre-authorization.  Find out ahead of time if the services you need require a pre-auth. Your claim could be denied if pre-authorization was needed and you didn’t get it before you received care. Services Needing Pre-authorization

See Your PCP Instead of a Specialist

See your Primary Care Physician (PCP) first for most medical needs. Because he or she knows you and your health history, you’ll get personalized advice. Together, you can make the right decisions for you. Why do you need a PCP?

Know What’s Covered in an Office Visit

Certain routine treatments are covered under the office visit copayment. But other more complex ones may be applied to your deductible (the amount you must pay before your insurance company starts to pay your claims) or coinsurance (your share of the cost of the service, such as 20%). Always check your official plan documents for the cost sharing amount for specific services.

Ask for Generic Drugs

Ask your doctor if a less expensive generic form of a prescription drug will work as well as a name brand for you. Your cost share will be lower with a generic.

Use Your Preventive Care Benefits

Routine preventive care like screenings, check-ups and counseling to prevent sickness, disease or other health problems are covered by most plans at no cost to you. Use these benefits for age-appropriate annual pap tests, mammograms, health exams, flu shots and more. Check your plan for details.

At your yearly wellness exam, make sure any tests done are included in the U.S. Preventive Services Task Force A and B Recommendations. Download a list of screenings covered under the QualChoice preventive care benefit.