You have insurance, now what?

doctor's office

Flickr Photo by Mercy Health


Maybe you have never had health insurance. Or perhaps it has been so long since you were last covered that you don’t recall how to use your policy or what to expect when you do.

Enrolling in an insurance plan is just the starting point for your journey through the health system.

To smooth your trip through the medical complex, and to maximize the benefits of your new insurance policy, here are some tips:

  1. Whether you enroll in a private plan or in Apple Health on Washington Healthplanfinder, you should receive an insurance or services card from your provider. This card has the policy number, activation dates and personal information that you need to share with your health professionals. Bring this card with you to every appointment.
  2. You should also receive a book containing information about your benefits. It will explain your plan’s policies such as prescription coverage, copayments, your provider network, substance abuse services and other specifics of your insurance.
  3. Verify that the clinician you want to see is in your network. You can usually do this online or by calling your insurance provider or your health care professional. To receive the full financial benefit of your plan, you should see a professional within network. Your insurer can help you select a primary care provider or a specialist that accepts your coverage. If, for some reason, your insurance does not cover a particular medical visit, you have the right to appeal that denial of coverage.
  4. If you have a medical emergency, call 911 or go to the closest emergency room. As soon as possible, contact your health insurance provider to inform them of the incident and at which facility you were treated. By law, your insurance company cannot charge you more for receiving emergency care at an out-of-network facility.
  5. Review the type of prescriptions your plan covers — you can do this in your benefits book or by calling the insurance provider. All medications are available to you, but your insurance will have a “formulary” (a list of approved medications) that will cost you less out-of-pocket. If the medication you require is not listed there, you can appeal to your insurer for an exception.
    Certain pharmacies, too, are treated as in-network facilities that offer greater cost savings. If you cannot reach one of these pharmacies, you can have your prescription mailed to you.

(Tips courtesy of Washington Health Care Authority.)

It’s like planning ahead when you travel: it helps to have your destination in mind and pack accordingly.

One comment on “You have insurance, now what?

  1. Reblogged this on YWCA Health Access: Empowering Women in Health and commented:
    Open enrollment through the Washington Health Benefit Exchange has come to a close, and lots of people living in WA have health insurance for the first time.

    Enrolling in health coverage was the first step! Now – how do we learn about how to use our health insurance to help us stay healthy?

    Public Health – Seattle & King County’s most recent blog post shares tips on how to use your insurance, now that you have it. Read more below!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s