Thursday, November 20, 2014

Using your health plan...tips and tricks, including $4 prescriptions!

Unless you work in health insurance or use your plan on a daily basis, you might not know the ins and outs of using your coverage. I always like to get the biggest bang for my buck, we might as well, we pay enough for our coverage! So here are a few tips and tricks to using your health plan. Health care costs are not going down, so let's save money where we can!

Preventive care is now covered at 100%. Meaning it is very important that you do get that annual physical because for one, it's free! And two, is very important that we get an annual screening each year. But when you go, make sure you are completely healthy and that you are just there for your annual screening. If you mention to the doctor you have a cough or cold, or aren't feeling well, he'll write that in his notes and the billing code will include an "illness". Then you'll get a bill! So if you aren't feeling well, make another sick appointment. That way your preventive screening is covered at 100%.

Always check that your doctor is in-network. Seeing a new doctor? Make sure to log on your carriers website and check to see if the doctor is listed as participating. Most carriers have apps now and you can check quickly, even on your way there! Using a participating provider vs non par provider can save you lots of money! I like to double check, out of network medical bills are NOT cheap, so if you aren't sure, call the doctors office and ask if they are contracted with your carrier (or give them the details of your health insurance card, for example PPO/HMO). They should be able to tell you if they have a contract with that carrier. The reason I say double check, our pediatrician participated with Anthem but didn't take our specific plan. So I just assumed our plan was in network and we were left with hundreds of dollars in denied claims! Seeing an in network doctor means the contracted rates for services are much lower, saving you and your plan money!

When we are sick and we just can't wait it's easy to run to urgent care rather than waiting on an appointment with your primary care doctor. But if it's not urgent, try to wait until the next day if you can. Urgent care visits are much cheaper than emergency room visits but more expensive than primary care visits. It's going to cost you a higher co-pay or out of pocket amount depending on how your plan pays, and it costs your health plan more in the long run. Sometimes when we know we have an ear infection, strep throat or a simple illness we can ask to see a nurse practitioner. It costs less to see them, even if it's in the same office as your doctor.

Prescription drugs can be expensive, especially if you are taking several maintenance meds each month. Depending on how your plan pays you probably pay a co-pay for each of those prescriptions. Depending on which tier it's on, depends on the co-pay you will pay. Co-pays for a one month supply of blood pressure medicine or an antibiotic can add up, add that to several members in your family and you might spend more on prescriptions than groceries.
It's not exactly "new" news but a few years ago pharmacies started offering $4 Generic prescription drug lists. Meaning if you were prescribed a drug that was considered "generic" it might be on this $4 drug list and instead of using your health insurance to get that prescription the pharmacy would ring you up for FOUR dollars! Genius in my opinion! The wholesale value of these common generic drugs is rather low, so if you are paying your copay through your health plan and it's on that drug list, you are overpaying.
My suggestion, when the doctor writes you a generic script, before you head to the pharmacy, check that list. If it's on there, make sure to tell them not to run it through your insurance and you'll get the $4 prescription. Hopefully they offer that to you anyways but it's always worth asking. You can also ask your doctor for a generic drug that you know is on that list. I'd much rather pay $4 than my $15 copay. Or, carry those handy $4 drug lists with you everywhere you go!



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