The new year is often a time of new resolutions and adventures. It's also when most health insurance plans begin. It's important to understand the coverage you have selected, but also how to choose your primary care provider and get the care you need.
- Read your benefits overview, usually available on your health plan's website.
- Know if there is a deductible — the amount you pay for health care services before your insurance plan starts to pay — and what counts toward it.
- Know when there is a copayment — often called a copay, which is a fixed amount you pay for a health care service after you've paid your deductible — or a coinsurance, your share of cost based on a percentage.
- Know where to go for all of your care, including outpatient, hospital and urgent care.
- Know when you need pre-authorization for care from your insurance provider.
"It is extremely important to review your benefits and understand the potential out-of-pocket costs you may have for health care services," says Kimberly Castillo, director of compliance and business services for Sharp Rees-Stealy Medical Centers. "Many plans require members to be treated by a health care provider that is contracted with their plan. If the provider is not contracted, it may result in higher out-of-pocket expenses or a denied claim."
Choosing a primary care provider (for patients with HMO insurance)
Step one in accessing health care is to select a primary care doctor, if you haven't already done so. This doctor will serve as your wellness and health care partner, and will coordinate your routine and specialty care. This includes everything from routine physicals to treating illnesses, ordering tests and, if you need it, referring you to specialists.
When choosing a primary care provider, it is important to consider whether a doctor is in your network, accepts new patients and offers easy ways to communicate through an online patient portal, such as FollowMyHealth®, an application that allows you to send messages to your doctor's office, make appointments, view your medical records and more.
If you are beginning your search for a doctor, this road map can help you along the way.
Your first visit
Once you have chosen your doctor, contact their office to schedule your first visit. This will be a time to develop a rapport with the care team, discuss your health history and any concerns you may have, and begin to build your partnership. Of course, if you have an urgent need, make sure to let them know.
To make the most of your visit, have your medical records, including your immunization record, sent to the office in advance of your appointment, and bring the following information with you:
- A list of your top concerns in order of importance.
- Medications, vitamins and supplements in original containers or a list of everything you take along with dosages.
- A list of any allergies to medications or food.
- A family health history, including any serious medical conditions of family members and their age of diagnosis.
- A notepad to take notes or someone who can take notes and ask questions on your behalf.
"Sharp has a team of knowledgeable people who can explain insurance benefits, help you find a doctor and, under most circumstances, provide estimates of what a service will cost," says Castillo. "This is all part of what we call The Sharp Experience."
Covered California's open enrollment period continues through Jan. 15. Sharp Health Plan is hosting free health insurance seminars and personalized enrollment workshops with certified enrollment counselors on-site to offer hands-on help. These are no-commitment classes where experts will help you find the right option for you — even if it is not Sharp Health Plan. You can sign up online or over the phone by calling 1-800-82-SHARP (1-800-827-4277).