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Part 2: All Things Healthcare

Part 2: All Things Healthcare

| November 10, 2021
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In Part 2 of our November Edu-Blog series on health insurance, I will go over two factors that I believe can help drive the cost of health insurance down on an individual basis. Now, these aren’t quick band-aid fixes; they simply take a different perspective on a few things. 


As a result, we now have more choices and more negotiating power, and it’s time to use those to our advantage. In the same way, we can call our insurance company and ask for a drug to be put on the approved list; we can ensure our other needs are also met. I’m not going to lie to you, it takes diligence and work, but I believe it’s totally worth it. Let’s start with my top two ways to gain some leverage when dealing with your insurance company.

Healthcare Cost Deflators

Telehealth goes mainstream

Although telehealth has been gaining ground slowly for years, the COVID-19 pandemic has forced its rapid adoption by both consumers and clinicians, many of whom had never used it before. 

Telehealth is something most insurance plans now offer, and I see the benefits in it. It has always bothered me that when I go to the doctor because I don’t feel good or something is going on that isn’t overly complicated, I end up sitting there, and they never even look at me after the RN takes my blood pressure. Why go through all that hassle and pay the copay for a sick visit, which can often be really high when you don’t have to. And let’s not forget urgent care facilities, the copays for those can be as high as your copay for a visit to the ER. 

Most of the time, when we go to the doctor, it is for pretty uncomplicated things. These types of visits can be easily handled with a simple telehealth appointment, and telehealth copays are usually much lower than sick visits to your doctor, the ER, or urgent care. Plus, you get all this from the comfort of your home. Needless to say, I urge all my clients to make use of telemedicine as much as possible because it does make a difference in your annual healthcare costs.

Narrowing down your plan 

I firmly believe in only paying for what you need, even when it comes to healthcare. I help my clients feel empowered to ask the right questions when dealing with insurance providers, so they get the right level of coverage. No, you don’t just have to accept a packaged plan that is one of many cookie cutters! You are unique; there is no one like you, so your health care plan should fit your needs as much as possible.


Whether you are part of an employer-based plan or self-insured, the best way to get your needs met is to ask the right questions. Here are the questions I encourage you to ask when choosing a healthcare plan for next year. Now I know you will think these are obvious questions, but most people know they should ask them and never do, or at least forget to ask all of them. Asking the right questions will ensure that you get the right plan and do not overpay for the wrong one.


  • What type of plan is it?


If it is an indemnity plan, you will pay a percentage of all medical costs. If it is a managed care plan, you will participate in either an HMO or PPO.³


  • How much will I have to pay for medical care?


Find out the amount of the premium. Next, ask whether you will be charged a co-payment, a small flat fee, perhaps $10, charged for health care services.³


  • Will I be able to use my current doctors?


Ask about any limits on choosing your doctors or hospitals. Ask for a list of the covered doctors and hospitals to decide if the plan is right for you.

  • What Benefits are included?


Ask if the plan covers dental, vision care, or other special services that you might need. Ask about prescriptions, too. Make sure you also ask what benefits are not included.³


  • Are routine examinations covered?


Ask about mammograms, pap tests, immunizations, and other routine check-ups.³


  • Will I have to call my doctor before going to the emergency room?


Some plans require you to contact your doctor within 24 hours of going to a hospital emergency room, or your costs won't be covered.³

  • What are the plan’s restrictions on pre-existing conditions?


If you or someone in your family has a chronic condition, the policy may not cover related medical costs for several months -- if ever. Ask how long pre-existing conditions are excluded from any plan you are considering.³

  • What happens when I am away from home?


If you need to go to the doctor while traveling, how much -- if any -- of the costs will the plan cover? How do you get reimbursed?³

  • Is the insurer financially stable?


Find out how long the company has been in business. You don't want to get a really good deal with low premiums, only to find out that you can only see a doctor during very limited hours.³


  • How does the company handle disputes over claims?


All insurance plans have procedures for appealing denied claims. Many require that you take your dispute to an arbitrator or an independent person who hears both sides and decides the claim’s fate. Ask what the company's average turn-around time is for resolving claim disputes.³



I know this is a lot of information, but don’t let it overwhelm you. I encourage you to print this out and use it while looking at your plan options for 2022. You’ll be glad you had the upper hand by getting all the information you need to make educated and cost-effective decisions. Remember, you pay the insurance companies, so they work for you!


Join me next week for Part 3, a discussion on effectively using your health plan once you have selected one. Have a wonderful week!



¹US Health Care Is in Flux. Here's What Employers Should Do.

²Download Medical cost trend: Behind the numbers 2021 

³https://www.WebMD.com/health-insurance/features/ten-questions-health-plan#1 



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