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What is your one best tip in getting the most out of your health insurance?

05-24-2010 by Colleen King

With all the discussion around health care coverage, the cost, who’s good and who’s not, I like to see my clients get the most they can from their health insurance.


The big tip–the excitement–drum roll please…..You want to use contracted providers whenever possible. With HMO (health maintenance organization) plans you don’t really have a choice. You have to see doctors contracted with the carrier or your care isn’t covered except in case of an emergency.


PPOs, preferred provider organizations, you have the option of using providers that are or aren’t contracted. If you use a doctor, hospital, outpatient surgery center, whatever, that IS contracted with your insurance carrier you get the benefit of a contracted rate. So even if you are paying for the care, like when you haven’t met your deductible yet, you get the benefit of the contracted rate, also known as a discounted rate or negotiated rate. This can really help–I had blood work that I was billed over $400 for last year, and once the negotiated rate was applied, it cost about $100. I still had to pay the bill, but would the lab have knocked it down 75%? I think not.


So either go to the web site of your insurance company (they all have them) or call them. You can also ask the office or hospital you are going to be going to if they are contracted but be sure to specify if you have an HMO or PPO plan. Just asking ‘do you take Aetna’ won’t help if you have an HMO and they only accept PPOs.


It may seem like a little thing, but believe me, it will make a difference.




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