Monday, November 29, 2010

If you were to take a class about your health insurance, what would you hope to learn?

I'm going to be offering a 4 hour class on helping people to better understand their health insurance and taking a pro-active approach to it, and want to make sure I cover topics and questions that people may have! I work in billing for a hospital, and am always helping my family and friends figure out what's going on with their insurance (especially if they have two), and was even able to save my mom over $1500 on a bill that was processed wrong by her insurance! Any thoughts or suggestions would be welcome!! Thank you!
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In summary, providing the tools to make informed decsions regarding their healthcare through price transparency and sound understand of the product. In my tavels, the #1 problem with healthcare is not setting the right expectations and relying on the perception that the carrier covers everything when you have an ID card which simply is not the case. Having to conduct open enrollment meetings myself I always include the following topics: 1. How a deductible works. (If applicable) 2. Coinsurance. (What it is) 3. Maximum out of pocket expenses. 4. Out of network vs. In-network treatment 5. Reasonable & Customary Payment logic for non-participating treatment. 6. Carrier Online Resources (doctor searches, transparency tools) 7. Prescription Drugs (Formulary & Co-pays) 8. HSA/HRA/FSA/POP - (if applicable) 9. Pre-certification- (When is it required) It is also important for the presenter not to set unreasonable expectations of payment or infering coverage for one paticular member or sitaution. The meeting should be designed to show the member the tools to find their answer rather then specifically addressing every concern. Each individuals sitaution may have an angle which will come back to bite you later.
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