(This guest post is authored by the Department of Regulatory Agencies – Division of Insurance)
Health insurance can seem overwhelming, but it doesn’t have to be. With some advance planning and information gathering,
consumers can be better prepared to use their health insurance. As many Coloradans are newly enrolled in health insurance, the Colorado Division of Insurance offers these tips on successfully using your health insurance. Colorado
1. Choosing a Doctor. Many insurance companies offer a search service on their websites for finding a provider or a facility that is “in network” (in most cases, meaning your costs will be less). You can also contact the customer service telephone number located on the back of your insurance card to find out how to choose a provider.
2. Prescriptions. Review your policy to see how your plan covers prescription drugs. Typically, insurance companies offer a detailed list (called a formulary) showing the types of drugs covered and how payments are categorized. Find out what types of drugs are covered and what you are required to pay. Remember, some medications may cost more than others and some may not be covered at all. Also, many insurance companies offer mail-in prescriptions at which you can receive 90-day supplies of many drugs for less than at a regular pharmacy.
3. Telephone Help. Many insurance companies now offer a dedicated telephone line (“nurse line,” “advice line,” “health line” or similar), allowing you to get medical advice on for a variety of issues. These can help you decide whether or not you need to see a doctor or seek emergency care. Look to your insurance carrier’s website or your insurance ID card for a health advice telephone number.
4. Emergency Care. Make sure you know which facilities are covered by your plan for after-hours and emergency care. Some facilities may not be included in your provider network. Especially if you have children, it’s helpful to know the nearest after-hours urgent care facilities that participate in your insurance.
5. Billing and Payments. Understand how you will pay, when you will pay and how you will be billed. Do you have a co-payment, coinsurance, and/or a deductible? With some plans you may be expected to make a partial payment at the time of service, with others you will be sent a bill after the service. If you don’t understand the amounts you are asked to pay, ask questions. Billing and payment mistakes happen in all areas of life, including healthcare.
6. Keep Good Records. After your visit to health care provider, you will receive an Explanation of Benefits (EOB), or a similar document, that communicates what portion of the provider fees you will be responsible to pay. Typically, this is not a bill, but a summary. Pay attention to these documents and the amounts shown. If something doesn’t look right, ask questions.
If you have questions about health insurance, the Colorado Division of Insurance can help you understand your options. If you have a problem or feel you’ve been treated unfairly, go to our website at www.dora.colorado.gov/healthinsurance or call us at 303-894-7490 or 1-800-930-3745 outside the metro area.