I've worked for 10 years at my county's public hospital, one of the busiest and largest hospitals in the country. During that time, I have seen a great deal of change in the healthcare industry and expect a whole lot more as Congress continues its debate on healthcare reform. More than ever, patients' insurance - or lack thereof - has become an issue that we must address on a daily basis, especially when it comes to individual health insurance. For those who are on their own plans and not receiving benefits from work, it can be especially confusing. People who fall into this category need even more help understanding the fine print and should pay even more attention to the complexities of their plan. Working at a facility that takes care of the insured and many, many uninsured, I've observed certain woes, challenges, and unseemingly important truths that would have saved my patients time, money and stress! I encourage everyone to be their own best advocate to make sure they get the best care and keep prices in check.
Know the nuts & bolts of your plan
Just because you have an insurance plan doesn't mean it's going to cover all that you may need! There is quite a range of insurance options and prices, and obviously those plans are going to cover different services and different needs. At times, a plan may not cover important items such as outpatient therapy, some services, nursing home or skilled nursing facility placement, or medical equipment. Additionally, many hospitals/ facilities do not accept or are out of network for certain plans - just because you have coverage may not mean that you'll be able to see that specialist you've heard such great things about.
Do your homework
Insurance groups have become very strict regarding approval of medications and testing/ imaging. Just because your doctor orders you a new medication, or wants further workup via imaging, doesn't mean that insurance will cover it. Almost always, they require adequate/ appropriate documentation explaining the reasoning for the medication or test. If not initially approved, at times they will allow a peer to peer provider discussion in order for the insurance company to consider approving a specific test or prescription. Other times, however, they will simply deny a test or study and will therefore not cover its cost. It's best to do your homework and know this in advance.
You often get what you pay for
Some of our patients have chosen the cheapest plan possible, which in turn may not financially assist with some of their healthcare needs. Insurance is expensive. There's no getting around that fact. But going for the cheapest plan doesn't always mean that's the best plan for you and your specific healthcare needs.
Play it safe
Insurance is critical to your health and financial security. No one plans for an accident or plans to get acutely ill - but it obviously happens. You must consider the "what if". Depending on your situation, you are potentially risking financial disaster if you deny healthcare coverage and then get very sick or get in a serious accident. I've had many patients who fear their hospital bill's impact on their life and future.
Use your resources
Be mindful that certain counties provide indigent care coverage for low-income households. Additionally, certain charities may provide financial assistance if you need a little extra help. Finally, there are services and websites like
Take Command Health that often
provide discounted prescription prices, which, depending on the prescribed medicines, can be a HUGE additional monthly cost for patients!