Pleasanton Weekly

- January 29, 2010

How to get the most out of your health benefits this year

It's 2010 and like millions of other Americans, you may be thinking about the next 12 months ahead of you. One resolution that many people may not consider is making the most of their new health benefits plan. By fully maximizing your benefits and learning the ins and outs of your plan, you could save yourself hundreds of dollars this year.

Experts say the most important first step is to review your health plan coverage documents carefully. This information may have been mailed to you or may be available online with your employer or health benefits carrier.

It is important to have a copy, because this is the official guide to your health benefits. It explains what the plan will or will not cover, including any special requirements or limitations on the coverage. For example, the policy will spell out any copayments, deductible and coinsurance amounts, referral requirements and limits on types of services.

Here are more tips, based on other people's experiences, to help you get the most out of your health benefits plan this year:

* An ounce of prevention is best, so make sure you get your preventive care. This includes yearly physicals, flu shots and some screenings. Many plans cover these services 100 percent.

* Use doctors and other health care providers that are in the health plan's network. If your plan requires you to select a primary care physician, then do so. Some plans will not cover your visit or treatment if the doctor is not in their network, so read your documents carefully or call your health plan's customer service department to find out. Even if you are covered for using a doctor outside your health plan's network, you save money by seeing someone in the network.

* If your doctor recommends any type of tests or lab work - outside of what is normally part of an annual physical - call your health plan to see if these require a preauthorization. Usually the doctor's office does this, but it doesn't hurt to check. If you get the test done without a preauthorization, your health plan may not cover the testing, which will leave you paying for it out of your pocket. (It is always a good idea to get copies of preauthorizations in writing.)

* Read your policy carefully if you need any type of therapy - for instance, physical, occupational or speech therapy. There are often limits on the number of visits and some have time limits for when you can receive the services after you are diagnosed.

* When Explanations of Benefits (EOBs) arrive, review them carefully. An EOB explains how a health benefits claim was paid. Be sure you were charged for the correct service and the correct amount. If you don't understand the information or something is incorrect, call your health plan or your doctor to resolve it.

* Understand your rights to file an appeal or grievance if a claim is denied that you feel should be paid. This information is typically explained on your EOB or you can call your health plan for instruction on how to do this. You may need to provide additional information for a claim to be reconsidered. There are timeframes for this so pay attention to those notes on your EOBs or in any correspondence you receive. Whenever contacting your health plan, have your member identification number, the date of service, and any documentation to support your appeal.

* Finally, most health plans are emphasizing wellness these days. So, see if yours offers incentives for healthy living or discounts on gym memberships and weight loss programs.

Average out-of-pocket costs, such as copayments, coinsurance and deductibles, are expected to increase nearly 10 percent in 2010, according to research group Hewitt Associates. It pays to know the ins and outs of your health benefits plan so you don't get caught paying more than necessary. For more tips on how to maximize your health benefits, download or order a free copy of "Navigating Your Health Benefits For Dummies" at

Courtesy of ARAcontent


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