Now that you have a new health plan for 2016, you might be wondering how to use it to save the most money on your healthcare. Simply put, you almost always save money by using doctors, hospitals and other healthcare providers that are in your health plan's network. Using in-network services is the easiest way to get the most bang for your buck.
Here are eight ways to take advantage of your plan's network of doctors and hospitals to save money all year long.
Understand what you get with “in-network” care
The first step is to find your network's name, which should be labeled on the ID card your health plan sent you. Your network includes the healthcare providers your health plan has negotiated with to determine how much services will cost.
You'll often pay less if you get care from in-network doctors and facilities, and some plans - like exclusive provider plans -offer no coverage at all for out-of-network services.
Find doctors in your network
If you already have a preferred doctor, check to see if they are part of your health plan's network. Premera members can find a doctor at premera.com or call customer service to get help locating in-network doctors.
When making an appointment, ask your doctor's office if they accept your health insurance and if that includes your specific health plan's network. Also check if your doctor is associated with an in-network hospital that can admit you so you'll know where to go if you have an urgent need.
Do your homework about planned treatments and procedures
Specialists (such as anesthesiologists) are sometimes brought in for certain services and procedures. And sometimes a planned service at an in-network hospital may not be covered because the specialist is not in your plan's network. Call your doctor to confirm that the care providers for your procedure are covered in your network.
Ask about lab facilities too
Whether it's an annual exam or a planned hospital procedure, your doctor may want to take a blood sample or run other tests. These require working with an independent lab for processing, which might not be in your network. If possible, ask your doctor to send tests to an in-network lab.
You can choose out-of-network services, but know the cost differences
Sometimes out-of-network healthcare is necessary, but make sure to be prepared for higher costs ahead of time. Also, keep in mind that some plans (like exclusive provider plans or PersonalCare Plans) will not cover out-of-network care. For individuals on these plans, this means you'll pay the entire amount and these costs won't count toward your deductible or out-of-pocket maximums.
Get pre-approval before you go
In many cases, it's your responsibility to ensure that your doctor gets pre-approval from your health plan that a planned medical service is covered. It's called “prior authorization.” Check with your health plan on these requirements.
Save on medications
Check with your plan on nearby in-network pharmacies. Premera members have access to a comprehensive nationwide network of retail pharmacies, as well as offering a convenient mail-order pharmacy option. Another way to save money is to ask your doctor and hospital to request generic prescriptions.
Be a good healthcare consumer
Finally, don't hesitate to be proactive if you have questions to help you make informed healthcare decisions. You have choices for what care you get and how you get it, and the costs associated with those choices can vary widely. Ask your doctor, call your health plan or review your benefit summary.