When shopping for health insurance there are several ways to negotiate a lower premium. The premium is the basic billing amount or cost to you, usually monthly, for coverage under a particular insurance plan. Premiums vary significantly depending on how you structure your deductibles, how health providers are chosen, how copayments are set, how catastrophic events are handled, and how normal health maintenance is addressed. If you can get your insurance provider to quantify each of these aspects up front, there may be a variety of ways to reduce costs at each of these levels.
CHOOSING PROVIDERS FOR NORMAL HEALTH MAINTENANCE-
If you are willing to use a Preferred Provider network or PPO-type plan, this can create lower copayments and standardized fees that are negotiated ahead of time, which saves costs on many levels. Ask the insurance company for access to their preferred provider list in online or paper format. Your existing doctor may be on their list, which can be a comforting prospect. Think about whether you are willing to switch doctors in order to use the insurance company’s PPO list. Also, if you should need a specialist, such as a urologist or immunologist, inquire as to how you would locate and choose one within the insurer’s network.
Ask the insurance company how they choose preferred providers and whether your doctor can easily get on their list. Also ask whether a provider with formal complaints can be dropped from the list; you will want to know if the PPO list implies a level of screening for quality. For example, if their PPO list contains only doctors that are new to the area, be wary of the standards used for the PPO list. If this is not a major concern for you and cost is far more important than the doctor’s resume, then a PPO plan may fit your needs well. For example, knowing up front that a women’s annual pap smear is a ten dollar copayment with the insurance covering the remainder of the cost may be your highest priority. For other consumers, the doctor’s background and the type of equipment used may be more important than the smaller copay. Pay attention to the insurer’s fees for lab work since many doctor appointments will have associated lab tests. If you know already that quarterly blood work is needed for a cholesterol condition try to estimate what discounts your insurer will offer on those services.
HANDLING CATATROPHIC EVENTS-
In the event of a hospital visit for appendicitis, a broken limb, severe injury, or other sudden unpredictable illness, you will want to know how the insurance company recommends a particular hospital. Sometimes a referral is needed in order to utilize a hospital. Some emergency situations offer exceptions to the referral process and you will want to know how to proceed before that situation comes up. Also, for major operations such as removal of a malignant tumor, you will want to know how diagnostic fees and referrals will work. CAT scans and MRI’s can cost thousands if insurance does not cover them, so be aware of the insurance policy’s requirements and limitations before setting up your coverage. For example, perhaps you can limit the covered MRI’s to one per year and get a savings plan for such a limitation.
The insurer may prefer that patients seek a first opinion at a walk-in clinic rather than a hospital in some cases. Ask the insurance company for their preferred procedure before signing up, because you may want the freedom of using your own discretion in an accident or emergency. For example, if a young child has a fever of 103 degrees how many prescreening phone calls are you willing to tolerate? How are ambulances covered? In the effort to discourage emergency room visits, some insurers will go to the extent of being imprudent with your family’s health, so seek this information earlier rather than later. If avoiding the emergency room is a restriction you can live with, the insurer will most likely offer significant savings plans for those consumers.
Opting for high deductible insurance on non-maintenance fees, such as scheduled and unscheduled hospital stays, can open up many possibilities for saving on premium costs. You may find it prudent to choose a generous annual cap for hospital fees while also opting for a deductible of $2,500 or more on catastrophic illnesses. Have the insurance company explain whether accidents and illnesses are handled on a different schedule or combined for purposes of calculating annual deductibles. If you want more coverage for accidents and less coverage for illnesses, a lowering of coverage in some categories may fit your situation. Also, it is preferable not to have inpatient and outpatient costs listed on separate schedules because so many hospitals discharge patients prior to 24 hours, even for significant surgeries and major injuries. You do not want to spend months haggling over a hospital bill due to the inpatient versus outpatient definition specified in the small print of your insurance policy.
Being aware of these options and negotiating each one can help you decide on the appropriate amount of coverage for your situation. Think of likely scenarios and worst case scenarios, then ponder how you would like to pay for health services if an accident or illness comes up. There are types of coverage you may not need at all. For example, if you are a woman over the age of 45, perhaps no maternity or obstetrical services are applicable. A policy without maternity benefits may offer significant cost savings. Conversely, if you are very healthy but expect to be pregnant soon, maybe being at or under a normal weight will give you a bonus in cost savings.
Revealing these personal preferences to an insurance agent may seem embarrassing at first, but try to approach them objectively and describe what you really need. Moreover, you can zoom in on cost savings by describing the positive aspects of your health, and making sure the insurer knows there are some health services that you definitely don’t need. Like looking for a vehicle, insurance policies have a sports car version, a mini-van, and an economy car, but there are several cars on the lot that are a bargain and in good condition. Keep looking until the fit and the price are both right.
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