NEWS FLASH -
How well do you know your health insurance?
By Dyan Quesada MPT, ATC

When you and your family are in need of a medical service, are you aware of your health insurance benefits? Unfortunately the average person waits until they require medical help to learn their insurance benefits. This could be financially costly and/or cause you to receive care from a practitioner you may not be comfortable with, based on your benefits. Educate yourself before you need medical help…

    ♦ Know the type of policy- The three basic types of health insurance are as follows:

HMO - This policy requires you to see a primary physician before you can see a specialist (e.g. an orthopaedist or neurologist.) HMO policies are very affordable, often have no deductibles, and have very low or no co-pays. The cons include the following: you are required to go to specific physician that your plan utilizes, and are required to pay the full amount of an office visit if you go to a physician outside of your plan. These policies limit certain types of treatments and number of treatments you are able to receive.

PPO - With this type of policy, you are able to see specialists without first seeing a primary physician. The advantage of this plan is have a “network” of physicians to select from. You are even able to see a physician or practitioner “out of network,” but are required to pay a higher co-pay. The downsides of this plan are as follows: there is usually a deductible that you pay out of pocket before your benefits are covered, and there is always a co-pay. If you go to an “out-of –network provider,” they may require you to pay for the entire treatment and then have your insurance company reimburse you.

Private Insurance - This policy gives you the freedom to see almost any health care practitioner, and places few limitations on types or duration of treatments. The only limitation is that the price of this policy is costly.

    ♦ Know your deductible and co-pay prior to seeing a medical practitioner. It has been
       the author’s experience that this is often a surprise for patients, as deductibles can
       range from $200 - $5000.

    ♦ Make sure you are aware of the payment policies of the facility you are seeking
       treatment from. Some offices do not accept insurance, or require fee payment at
       the time services are rendered.

    ♦ Check to see that your policy covers the type of treatment you are seeking.
        Some insurances may cover an “alternative treatment” instead of your choice
        treatment, if it is less expensive.

    ♦ Take the time to research a policy that works for you. Ask yourself questions
        such as: Do I want my policy to pay for maintenance checkups, or just utilize
        it for emergent situations?

By educating yourself on your health insurance, you will ensure that you and your family will receive the best medical care.