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Quick "first of the year" insurance checklist

By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"

Patient Advocate, Certified Mediator

AdvimedPro


November 25, 2024


With the new year, right around the corner, are there things you should be doing, especially with a new insurance plan? Yes! Here is what to do in late December, or early January. 


A. Review the financial details


  • Do you pay premiums or a part of them? what can you expect to pay?

  • Find out what the new out of pocket cost will be: deductible and co-insurance for individual members and for the whole family

  • How much is your new co-pay for office or specialist visits, or ER visits?

  • Create an online portal for easy access to that and other information, plan coverage details and terms of policy. You also can find In Network providers, see EOBs, check authorization status, download a copy of your card, send messages if you have questions, keep track of how much of your share of cost you have met so far and get cost estimates.


B. Update things


  • Got a new card? Send a copy to every provider you expect to see in the new year. And don't forget the pharmacy!

  • Get a new PCP if your current one does not participate in your new plan. The PCP is the hub for your medical records. they handle your basic care, and can refer you to specialists and for you, HMO patients, getting a PCP is a must as they authorize care by external specialists or medical providers.

  • Consult your new plan's list of In Network providers to see if your current medical providers are on it. If yes, great! If not, try and find someone who can render the same level of care and to whom your treatment or health management can be safely transferred early in the year.


C. Authorizations status


  • If you have a current authorization, especially for Out if Network service at In Network rate, make sure to ask the provider to transfer the authorization to the new plan. Or do it yourself by filing a request for "Continuation of Care"

  • Are the services, treatment, Rx you are currently receiving still covered under the new plan? Time for a call or perusing the policy and new plan's medical policies. You would need to file a request for an exception in order to continue, of the new plan does not cover it or lists it as an "exception"

  • contact HR or your new insurance representative if you have any questions about your eligibility or that of your dependents, or about any insurance coverage issue, but do expect a lot of delays, especially in the first two weeks in January.


 


new year fireworks


 Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.

 

(424) 999 4705 - F (424) 226 1330 - @martine brousse 2024 @ the medical bill whisperer 2024™

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