Know Your Benefits

What do you think of when you hear New Years?  Starting over, resolutions, new diet (yet again), college football games, black eyed peas (eat for good luck), and the list goes on and on.  One thing that pops into my head when I think of New Years is Insurance.  Yep you read that right...Insurance.  

I am a Social Worker and am a Care Manager for a large company that manages the mental health and chemical dependency insurance benefits for millions of people across the US.  Every year January is a hectic month with thousands of new members and new requests.  All this leads me to ask you---Do you know what your health benefits are??  Seriously---do you?  This really is an important question.  People I talk to know they have insurance but are not aware of the specifics of what is and is not covered.  Most people I talk too hate insurance companies.  The common thought is that insurance is there only to deny and make your life hell.  Well here are some tips to make your insurance life easier in 2009.

1.  Know your benefits!  Know what is covered, not covered, your deductible, co-pays and maximums.  Never go blindly into a doctors appointment without knowing that information.  Knowing that information will keep you from costly expenses after the fact.

2.  Pre-cert, Pre-cert, Pre-cert.  If your doctor recommends something--YOU call your insurance company to see if it is covered and if it needs to be pre-certified.  As always keep documentation of who you spoke too, time, date, their location and what was discussed.  If the company tells you something is not covered ask why, ask if exceptions can be made, and if not is there an alternative treatment that is covered.  If something is not covered that your doctor believes is necessary have that doctor advocate for you to the insurance company either by speaking to a clinician or writing a letter.  If need be even see if your human resources representative can advocate for you---of course make sure you have signed a release of information with your insurance company so they knows it is legal to speak to your human resources representative.

3.  If you feel you are not being treated fairly, always remember that their are complaint departments within your insurance company that you may access.  Don't be afraid to complain but please be nice.

The keys are knowledge and advocating for yourself. Don't just take your physicians word that something is covered.  Always follow up with a phone call yourself and document, document, and document.  Sometimes it may even take several phone calls.  It will probably seem like a hassle at first but in the end you will decrease your stress and ensure that you will not receive a surprise bill at the end of your care.  KNOW YOUR BENEFITS!  Here is wishing you all a Healthy New Year.