All About Insurance

The new year marks the start of new insurance and benefits. Understanding you insurance policy is vital to receiving timely care at a reasonable cost. Let's talk all things insurance so you can be empowered this year. 

What is insurance?
Health insurance is a contract that agrees to pay a portion of health and medical expenses in exchange for a premium. This generally covers the cost of routine care, emergency services, specialty care, and the treatment of chronic illness. 

What kind of insurance are there?
There are a wide variety of insurance policies available in today’s market. Two of the most common are Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO). 

• PPO: allow patients to be seen by providers inside and outside of their network
• HMO: tend to restrict patients to a limited network of providers
  • HMOs also often require additional steps prior to a patient having an appointment with a provider. These can include referral authorizations and/or prior authorizations for procedures and/or medications. Without proper documentation and information, care can be unnecessarily delayed by weeks. 

Why do we ask?
By asking about insurance, we are able to ensure that our patients are getting efficient and effective care. For example, the following may be affected by inaccurate insurance information:

• Referral authorizations
• Prior authorizations for procedures and medications
• Virtual visits
• Copay due at the time of service

How can you be proactive in your care?

• Call your providers as soon as you have a change in insurance. These updates include, but are not limited to:
  • The policy type
  • Policy, member, or group numbers
  • Copays and coinsurances
  • Insured and/or responsible parties
• Call your providers and/or insurance company to ensure network status before initiating a change
• Request referral from your established Primary Care Physician (PCP) and prior authorizations before appointments

While insurance can be a tricky subject, we hope this helps. If you have any further questions about your coverage, call your policy directly for more information. Don't forget to let your doctor's offices know if you have had any changes in any of your policy details!

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