Understanding how your health insurance works is a vital component of being prepared.
Follow these simple guidelines to fully utilize your benefits:
1. Know your insurance carriers – your medical insurance carriers could be different than your vision insurance carriers. For example, you may have Blue Cross and Blue Shield for your medical or health insurance, but you may have Eyemed for your vision insurance plan. Understanding your carriers and knowing what carrier covers which benefit will help you maximize all of your benefits. Make sure you have your insurance cards handy when making an appointment at any healthcare provider. Knowing your member ID numbers will help eliminate endless phone calls between you and your provider which will save you time when making appointments. By giving your provider the correct member ID number beforehand, your appointment will be uninterrupted by unanswered insurance questions.
2. Understand the specific “in-network” and “out-of-network” coverage benefits of your health plan. This can be crucial when selecting a provider because in-network benefits leave members with a much smaller out-of-pocket responsibility to pay than out-of-network. Your insurance providers should make a list available to you of every provider in your area that participates with that specific insurance company, maximizing your in-network insurance benefits.
3. Referrals are extremely important; knowing before you go to your appointment if your carrier requires a referral will save you time and unexpected out-of-pocket cost. You may be required to contact your Primary Care Provider (PCP) before seeing a specialist. Make sure you receive prior authorization from your PCP if required, otherwise some benefits may not be covered.
4. Know your out-of-pocket balance before making your appointment. Contact your insurance company’s customer service to find out what your out-of-pocket limit is, as well as your remaining out-of-pocket balance. **NOTE** You will not receive your maximum insurance benefits until your deductible, out-of-pocket maximum, and any other benefit plan requirements are met.
5. Know your service eligible dates; check if your hardware benefits, such as frames and lenses, are covered by insurance every 12 months or 24 months. This will help you to maximize your benefit and eliminate unexpected out-of-pocket cost when choosing glasses or contact lenses.