What do you do when your doctor doesn't take insurance anymore? Do you still go to the same doctor?
Doctors or service providers who do not accept insurance have made a business decision not to sign any contracts with any health insurance providers.
Essentially, they have decided that the payment the insurance company is offering for their services is inadequate and have declined to work providers. When you are looking at your insurance options, you may be considering "Out of Network" coverage. This usually means that your insurance provider will pay a certain per cent of the bill from an out of network provider. You will be expected to pay the health care service provider at the time of services. Then, you may apply to your insurance company for reimbursement for some of you bill or for a credit toward your deductible. If the service providers file this request on your behalf, it is called "Courtesy Billing". If they want you to do this, they will give you a Universal Claim Request (UCR) and you will mail the form to your provider and follow up with the insurance company as to how this visit will be addressed. If you know in advance that there are doctors who "Don't Accept Insurance", should you sign up for "Out of Network"
Coverage during open enrollment? Maybe yes, maybe no. It depends upon the terms of your plan and the contract. It also depends upon the type of services that you are receiving and how your plan is designed. There are several questions you will need to ask your plan administrator before making a choice:
- If I am seeing an out of network provider, how do you allocate credit for services received?
- If you have a child with special needs who is receiving supportive services from your state, how will the plan manage your co-payments?
- How much credit do I receive for services received by an out of network provider - is it a flat percentage?
How do you get mployees to take full advantage of them of your insurance offerings?
I (the decision maker) made a strategic move to manager health care costs. However, my employees don't understand the choices we have implemented so they are not taking full advantage of them!!
That is exactly my passion! Giving employees control over many of these choices is a massive PARADIGM SHIFT that they struggle to understand. It is like teaching your children to drive and giving them access to a car, but not continually coaching them over the next few years every time you are in the car with them as they encounter different situations.
They need on-going support and education or this excellent choice you made will frustrate you and them even further.
I can provide you with the framework to coach your employees through this time of transition!
Hospitals all over the NY/NJ/CT area lost power over the last week.
Did you have to get care at a hospital or at a new caregiver? You might get an unexpected bill and owe more than you think. Is the bill fair? Do you have to pay it? Do you have any rights in this situation? This is a perfect place to use a health care advocate. Health care advocates are there to help you with these billing problems and they don't cost nearly what you might think.