What to Ask When Choosing Your Healthcare Plan
The 2022 open enrollment period opened on November 1st and ends on December 15th, 2021, this means that many of us are actively shopping for the health care plan that bests suits our needs and budget.
To get the most out of our medical insurance plans, we must understand how the plans work, and what they cover. State and Federal insurance laws obligate insurers to include certain benefits and provide certain protections; however, insurers offer different plans from which you can choose, some will provide more coverage and protection than others, but this usually means the extra coverage comes at a price.
When you are shopping for healthcare coverage, insurance companies will provide a summary of each of their plans, this information will help you choose the right plan for you and your family. But, keep in mind the insurers won’t provide all the details of the plan until you have enrolled in the plan.
What is a Healthcare Policy?
For all intent and purposes, a health care policy is a legal contract between you and the health insurance company or health maintenance organization (HMO). When you enroll in a program, the insurance company or HMO will provide a copy of the contract, this will give detailed information about what your rights and responsibilities are under the plan.
For more information on the types of plans offered in Texas, please visit the Texas Department of Insurance (TDI)
Can I Cancel the Plan If I am Not Satisfied with the Coverage?
Yes, when you receive your copy of the policy detailing all the benefits, it is essential you read it carefully, especially if you have any special health needs. This will be the first time you are seeing the details of the coverage you will receive, and it’s important for you to know that if you are not satisfied with the policy, you have 10 days to return it and get a refund of your premium.
What is the Best Way to Compare Plans?
When you are shopping for medical insurance, ask the provider for their summary of benefits and coverage. This is the best way for you to compare healthcare plans as this document uses a standardized format making it easier to compare one item to another.
This summary outlines the basic coverage and cost of the plan you are interested in and will include the following:
- Benefits and Exclusions
- Links to Your Preferred Provider Directory and Drug Formulary
- Deductible Amount
- Coinsurance and Copayment Amounts
- Out-of-Pocket limits
- Referral Requirements
Always Ask About Emergency Medical Coverage
State and Federal laws obligate insurance companies to include Emergency Medical coverage in their policies. However, as we mentioned before, how much is covered can change from one plan to the next. As of August 6th, 2018, the Texas Department of Insurance (TDI) approved a controversial new program which grants the largest Health Insurance company in Texas to deny payments for some ER visits. Therefore, it is crucial to ask how your plan will process emergency medical treatment and ER visits before you enroll.
Can You Appeal a Payment on ER Treatments?
Absolutely, every consumer has the right to appeal the insurance company’s decision to not pay for treatment received in the ER.
According to the TDI, they received assurances from the insurance company that patients will have the right to have their doctor debate the treatment plan provided with the insurer doctor before a denial of payment was issued, and patients will be able to appeal the denial with an independent review organization.
Altus Emergency Center’s Patient Advocate department is available to patients to review their health insurance claims and to aid in the event of an appeal of payment denial. Our priority is and always has been the wellbeing of our patients, and our doctors follow care protocols to ensure the best medical care is provided.
Know Where to Go In the Event of an Emergency
If you are ever in need of quality emergency care, you will not have to wait in line at Altus Emergency Centers. All of our ERs are fully equipped and open 24/7.