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Your personal cost of health care: basics to know your health care plan

If you feel your health care journey looks like a winding road to get your claim paid, fear not. We will begin the informational journey together.

Our journey begins with the pre-registration process and what does your health plan cover, which will be covered in this post. So you probably ask your self – what does pre-registration mean and how can it help me especially where my health care coverage is concerned?  For planned hospitalizations, a hospital representative (patient registrar) may call you a few days prior to your admission to ‘pre-register’ you for your stay. They will ask for information about your health, emergency contact, billing and insurance coverage. Always remember to bring in your insurance cards the day of your appointment so that it can be scanned.

Some important information that will be asked includes patient name, gender, date of birth, phone numbers, home address, next of kin. All of this information gets entered into our health care information system to ensure the proper billing takes place for your visit.

Keep in mind these basics to knowing your health care plan:

Know Your Health Insurance Benefits
Most patients are given a medical identification card when they are enrolled in a medical plan. Go to the health insurance website listed on the back of your health card or call the 800 number listed.

Here are the questions you need to ask your health insurance plan:

  • Is this an HMO, PPO, or traditional fee for service plan? And what does that mean?
  • Can I choose my own doctor?
  • What do I pay for office visits?
  • Where do I find a list of doctors and hospitals who are listed as your
  • What is my co-payment for an office visit with a family practice doctor?
  • What is my co-payment for an office visit with a specialist?
  • What is my deductible?
  • Does my insurance cover cancer treatments, surgery, and physical therapy?
  • What is my deductible applied to? Cancer treatment, surgery, physical therapy?
  • What percentage do I pay for a colonoscopy, mammogram, MRI, or x-rays?
  • What percentage do I pay for hospitalization, room and board or surgery?
  • What is my lifetime maximum benefit?
  • Question to ask your human resources office:
  • Do we have a “Health Savings Plan” coupled with our insurance plan?

Once you get all of these questions answered, write them down for future reference. Remember, you plan can change from year to year. So, you must remember to update your reference sheet.

Be on the lookout for my next post, what happens if I don’t know my health plan and providing the right information to my provider.

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