Dear Patients,

October through December is typically open season for choosing an insurance plan for the upcoming year. When selecting a plan with an eye to going out of the plan network (e.g. The Kaplan Center) there are important pieces of information to know in order to make an informed decision.

Here are 5 questions to ask an insurance provider before selecting your plan.

  1. What is the out-of-network deductible?
  2. Is the out-of-network deductible separate from my in-network deductible?
  3. What is the coinsurance?
  4. What is the maximum amount of out-of-pocket expenses I will be required to pay annually?
  5. How does the plan determine the out-of-network allowed amount? Many use the Medicare fee schedule which is not always to the patient’s advantage. For Federal employees this information can be found in each of the offered Health Plan Overview documents.

Also, please think back to your experience this year with your current insurance company and ask yourself a few more questions:

  • Were my claims paid fully and without delay?
  • Did I have to work too hard to get the benefits of the plan that I paid for? For example, did my insurance company delay payment on claims while they requested medical records?
  • Did they ask on one claim or for many claims?
  • Did I have to appeal any denials?

Dealing with your insurance company should not be your part time job, though for some that’s what it has become.

The way insurance companies operate these days is not as cut and dry as it was a decade ago, and it is likely to get worse. Frankly, some carriers are more difficult to deal with than others and if you have a choice, please make a smart, informed choice. This decision should be based on: 1) the information you gather about what the plans offer (including prescription coverage for medications that you take) from available documents describing the plan – or better yet, the plan contract, 2) talking to co-worker experiences, and 3) any direct inquires you make to the insurance company.

If your employer offers FSA (flexible spending account) you should consider taking advantage of your FSA options. It is a terrific, easy way to save on taxes and spread out that portion of your healthcare cost over the year if you are able to estimate your out of pocket liability for the year.

If you have any questions, please feel free to talk to me. I can be reached by phone at 703-532-4892, ext. 603.

June Guzdowski
Billing Director, Kaplan Center for Integrative Medicine

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