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

Oct 16, 2018 10:22:03 AM / by Alex Hays

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If you have an PPO plan, your healthcare is fairly open ended and you are able to make decisions about your health care that you wouldn’t be able to make with an HMO. Knowing how to get the most out of your PPO is going to be extremely important if you want to get the best care for the best cost. Even if you are perfectly healthy now, 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 doctors and facilities for you to choose from
    2. Contact info if you have a question
    3. Virtual appointments
    4. Prescription management - compare costs, get refills or switch to home delivery
    5. Digital ID Card
    6. Deductible tracking
    7. Bill tracking and payments
    8. Cost estimation tools and cost comparisons

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) Use in-network doctors/facilities as often as you can. With your PPO, you have access to out of network options if you need to. However, most plans have separate deductibles and out of pocket maximums for each. That means that if you spend $2000 at an out of network doctor and $1,000 at an in-network doctor, those two amounts go to two separate deductibles. It’s going to save you a lot of money if you just stick to in-network doctors/facilities.

If you are having surgery and your doctor isn’t doing it in their facility, you’ll also want to check the facility that they are referring you to. Your doctor may be in-network but the facility they are sending you to may not be. Just make sure to check that before going in for any procedures. Another important thing to note is that most anesthesiologists are not in network. They are so specialized and so necessary that they don’t need to partner with insurance companies to be needed so they don’t. Talk to your insurance company about what their policy is around out-of-network anesthesiologists before your procedure.

7) Compare costs. Before you go in for any procedures, it’s always good to compare costs. For example, if you need to have an MRI done, there are options. Your doctor may refer you somewhere, but you are able to use the carrier website or mobile app to compare the out of pocket costs if you get the MRI done at different facilities. If you take the time to look into it, you can save quite a bit of money.

If your procedure doesn’t have the flexibility to allow you to compare costs, you should always get pre-authorization for procedures. Whether it’s an in-patient or out-patient surgery, getting pre-authorization will confirm that everything is covered and will give you a better idea of the out of pocket costs you’ll have.

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 PPO 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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