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What Your Employees Ask: How Do I Get the Most out of My HMO?

Nov 20, 2018 2:00:00 PM / by Alex Hays

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If you have an HMO plan, your healthcare is pretty well structured and costs are very clear up front. However, there are still things that you should know to get the most out of your HMO plan. Even if you are completely healthy, it’s a good idea to know how to take steps to prevent future issues and to make sure that you are ready if an issue were to arise.

1) Register on your carrier’s website. These websites were created to benefit you so there are various tools that can help you manage your healthcare. Most carrier’s have tools such as:

    1. A list of in-network facilities for you to choose from
    2. Online appointment scheduling
    3. Contact info if you have a question
    4. Messaging your doctor directly
    5. Virtual appointments
    6. Digital ID Card
    7. Deductible tracking
    8. Requesting prescription refills
    9. Bill tracking and payments

Using these tools can help you get a better understanding of your insurance and help you to take control over your healthcare outside of your appointments.

2) Take advantage of the 24/7 nurse line. This service is provided free of cost and is offered by most providers. You can give them a call if you are sick and would like advice on what you can do to get better faster, if you aren’t sure if you need to go see a doctor or need to visit a hospital, if you have questions about your prescription, or any other health related question. It’s a great resource for you, especially outside of your primary care physician’s working hours.

3) Go to Urgent Care instead of the ER if you can. Obviously you should go straight to the Emergency Room if your situation is “life or limb.” However, if it’s something less serious like the flu and it’s the weekend and you need to see a doctor, it’s better to go to Urgent Care than the ER for a couple of reasons. First, your wallet will thank you. Urgent care is typically far less expensive than the ER. Second, is the wait time. ER patients are seen in order of severity so if you have the flu and someone else comes in with a broken arm, the broken arm will probably been seen before you. However, Urgent care centers see patients in order of appearance so if you were the third one in, you’ll be the third one seen.

If you aren’t sure if you should go to the ER or Urgent Care, call the 24/7 nurse line and they can help you figure out which is right for you.

4) Actively manage your prescriptions. If your doctor is writing you a prescription, it’s a good idea to ask them about generic alternatives. Generic is always going to be less expensive than brand name drugs and are usually equally as effective. However, it’s a good idea to ask your doctor because it varies by prescription. You can also usually save money by ordering mail delivery for prescriptions you refill regularly. For example, if you have a monthly prescription, you can usually get a 90 day supply sent straight to your house for a lower cost than picking it up at the pharmacy each month.

5) Go to your annual preventative care appointment(s). Preventative care is covered at 100% so you pay nothing so why wouldn’t you go to these appointments? For many groups, the carriers keep track of how many people go to their preventative care appointments and they see this as a favorable activity. By going to your appointment, you may be assisting in keeping the cost increase down at next year’s renewal. Preventative care includes some vaccinations, well-baby visits, annual check-ups, annual pap smears, etc. When you go in for these appointments, just be clear that you are there for a preventative care visit. If it has been a while since your last appointment, your doctor may ask if you want to run additional tests. Some of these tests may not be covered under your preventative care appointment so always ask. For example, during an annual exam, it is common for the doctor to ask about running additional blood tests. These tests are not always covered so be sure to ask.

6) Make sure you know what to do if you have an emergency while out of network. Most HMOs have a policy in place if you happen to have an emergency situation outside of their network area. For example, if you have Kaiser and are in a state that doesn’t have Kaiser, you are able to go to any hospital and it will be covered as if it were in network. They ask that you call your Kaiser primary care physician to notify them of the situation so that they can get thing started on their end so that the billing is done correctly. However, the process may vary based on which HMO you are a member of. It is also good to know what the out of country coverage may be like since you may not always travel with additional health insurance. Many offer the same policy as their in country out of network area coverage.

Knowing some simple tips such as these can help a lot in the long run. Knowing what needs to be done and tools you can use to make your health management easier is vital with the current state of health care. The more action you take to manage it yourself and to be proactive, the better of you will be both with your health and with your finances. If you have more questions about how to get the most out of your HMO plan, speak with your doctor or talk to your broker!

Topics: What Your Employees Ask

Alex Hays

Written by Alex Hays

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