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Using My Health Plan

How do I stay healthy now that I have insurance?

Once you have picked your plan and have health insurance, you can take advantage of what your plan offers, such as free health screenings, annual immunizations, smoking cessation programs, maternity and new baby programs, and more. If you are due for an annual well visit with your Primary Care Physician (PCP) – schedule your appointment. Also Learn More >>

What are the benefits of receiving treatment through my insurance?

When you pick a health insurance plan, you will receive information on the types of treatments, healthcare providers, hospitals, and prescriptions that are included in your coverage. By obtaining treatment through your plan, you will receive discounts on providers, treatments, therapies, and prescriptions, as long as you stay within your network. Be sure to contact Learn More >>

How can I be my own best advocate?

There are many resources available to help you understand your rights and receive assistance, including: Your state’s department of insurance; Your state’s department of health; Your state’s health ombudsman (or other long-term care resource); Your state’s exchange; Your state’s Medicaid agency. Learn More >>

What does my plan cover?

All plans must cover recommended preventive care at no cost to you, as long as you see an in-network provider. Further, all plans must also provide what are called the essential health benefits. The type and level of the plan you have will determine which providers you can see and how much you will pay for a Learn More >>

What prevention benefits are available through my health plan?

Health insurance plans offer many benefits to help you get healthy and stay healthy. While benefits vary from plan to plan, most offer free health screenings, annual immunizations, smoking cessation programs, maternity and new baby programs, and more. Many offer discounted gym memberships, weight loss programs, and fitness programs. Be sure to contact your health Learn More >>

What other benefits might be available through a health plan?

Health insurance plans offer many benefits to help you get healthy and stay healthy. While benefits vary from plan to plan, most offer free health screenings, annual immunizations, smoking cessation programs, maternity and new baby programs, and more. Many offer discounted gym memberships, weight loss programs, and fitness programs. Be sure to contact your health Learn More >>

How can I use health plan benefits to manage my condition?

People living with a chronic health condition may be able to get help from their health plans. Many health plans offer programs aimed at helping people with chronic diseases understand the day-to-day management of their condition. Some plans also offer resources to track your progress, educational material, and support from a nurse coach (usually via Learn More >>

What if I don’t feel well?

If you are not feeling well, then you may need to see a doctor. The type of doctor or healthcare provider you should see (primary care providers,urgent care, ER) will depend on the types of symptoms you have. Learn more about how to pick the right location for care. Learn More >>

Why is it important to establish a partnership with my healthcare provider?

Today, patients are taking an increasingly active role in their health, whether through researching symptoms online or reading studies in magazines. As a result, healthcare providers now also want patients to come to them with questions so that they can help guide them to better health. Ensuring that you are an informed consumer and working Learn More >>

How do I choose a healthcare provider?

Health insurance companies contract, or enter into agreements, with healthcare providers – doctors, specialists, and hospitals – to provide their members with quality care at a discounted rate. These providers are called “in-network providers.” Providers that don’t contract with the health insurance company are called “out-of-network” providers. Because the health insurance company has negotiated a Learn More >>

Do I have a personal health record available, and how do I access it?

Keeping track of medical records can be difficult, especially if you have many healthcare providers addressing health concerns. While your doctors will keep their own medical records for a period of time, you should maintain your own personal health records (PHR). This can include recording past appointments, test results, prescriptions, and more. There are a Learn More >>

How do I select my primary care physician?

Rather than specializing in a specific area of medicine, a Primary Care Physician (PCP) sees patients regularly for preventive services (like immunizations and annual check-ups) and helps people maintain their overall health. Choosing a PCP is an important health decision and if possible you should spend some time researching your options. In most cases, your PCP Learn More >>

How do I set up an initial wellness visit with my primary care physician?

Your first step should be selecting your Primary Care Physician (PCP), and reporting this to your health plan (if required). Typically health maintenance organizations (HMOs) require patients to choose and report a PCP. If you are unsure whether or not you need to select a PCP you should call your health plan. For help on Learn More >>

How do I determine where to go to receive care?

Making the right choice about where to seek care helps ensure that you receive appropriate care in the right place and at the right cost. There are three major types of care facilities: Primary Care: You should visit your primary care provider (PCP) if you are in need of a routine check-up, preventive care or Learn More >>

What factors go into the cost of a healthcare provider visit?

The cost of your visit will depend on the plan you have, whether or not you have met your deductible (if you have one), the provider you see, and other factors. Be sure to contact your health plan to determine your specific costs. Learn More >>

How do I get the most out of my appointments?

To make sure you are getting the most out of your visit to your healthcare provider, it is important to be prepared. Below are some helpful tips: Before your appointment Make a list of any questions or concerns you may want to discuss with your provider. Examples include: “What is causing me to feel this Learn More >>

Where can I get more information about my diagnosis?

When your healthcare provider gives you a diagnosis, you should ask questions to get as much information as possible. You should also consider getting a second opinion. Click here to see some of our preferred links that provide information on conditions and diseases. Learn More >>

How do I get referrals?

Click here to find referrals to healthcare providers in your area. Remember to make sure that any healthcare provider you select is in your health plan’s provider network. What if you have a condition that requires the expertise of a specialist? If you need to see a specialist you should start by consulting your primary Learn More >>

Why might I need to see a specialist?

Your primary care physician has a wealth of knowledge in a broad range of subject matters, but if they feel you need more in-depth care for a condition from which you might be suffering, they will refer you to a specialist who will be better equipped to handle the condition. A specialist will have more Learn More >>

What questions should I ask my provider about my medications?

Be sure to talk with your provider or pharmacist about the drugs you take or are about to start taking. Before you start taking a medication, the the U.S. Pharmacopeia (USP) recommends you ask your doctor or pharmacist the following questions: What are the brand and generic names of the medicine? What is the medicine Learn More >>

Should I get a brand name or generic drug?

Many people have questions about brand name and generic drugs. When your healthcare provider prescribes a medication ask whether they are prescribing the brand or generic version of the drug. You should also check with your insurance company to see what they cover. Find out whether a generic, or non-brand name drug is available and Learn More >>

Where can I get more information about the drug prescribed to me?

Please see our helpful links to find more information about the drug prescribed to you by your healthcare provider. Learn More >>

What is a drug interaction?

Certain medications should not be taken in combination with other prescription or over-the-counter (OTC) drugs and others might require that you avoid certain foods or beverages. If your healthcare provider has prescribed a new medication it is important that you tell him or her about all the prescription and OTC medications you are currently taking Learn More >>

How do I ensure I take my medication correctly?

Taking medications as directed, also called “medication adherence”, is important to staying healthy, especially if you have a long-term health problem like asthma or diabetes. You have a better chance of a healthier future when you take your medications as directed. According to the Script Your Future Campaign, many people never fill their prescriptions, or Learn More >>

How can I better manage my medications?

Mail order option For some people, having prescriptions filled at the local pharmacy may work best. For others, it may be easier to get medications by mail order. Mail order pharmacies can make it easy to manage your medications by offering: Convenience. You get a three-month supply of medication with each order so you only Learn More >>

What factors go into the cost of a prescription?

The cost of your prescription will depend, in part, on: What insurance plan you have, Whether the drug is on your plan’s formulary, Whether you have met your deductible (if you have one), and Where you get your prescription filled. Other factors may come into play to determine the cost of your prescription. Be sure Learn More >>

How do I know what pharmacies are in-network?

Pharmacies are similar to healthcare providers and hospitals in that some are in-network and some are out-of-network. To find out if a pharmacy is in your plan’s network, check with your insurance plan. Most retail pharmacies, such as CVS and Walgreens, will fill short-term prescriptions and you may also be able to purchase a 31-90 Learn More >>

What is a drug formulary?

A drug formulary is a list of prescription drugs—both generic and brand name—that are preferred by your health plan. Often health plans will only pay for medications included on this list, unless your healthcare provider consults with your health plan to get approval for a drug that is not listed. A committee of nurses, doctors Learn More >>

What is a specialty medication?

Specialty medications treat serious health conditions such as cancer, Multiple Sclerosis (MS), and rheumatoid arthritis. They are complex and expensive, and may require intensive monitoring. Most specialty drugs are given by injection and require special handling and administration. To receive a specialty drug, you will need a prescription from your healthcare provider. You can look Learn More >>

How can I get help if I can’t afford my prescription?

Prescriptions can be very expensive, especially if you are taking a specialty medication. There are a few things that you can do if you cannot afford your prescription. Typical Prescriptions See if a generic is available. Ask your healthcare provider or pharmacist if there is a generic version of the drug you have been prescribed. Learn More >>

Are there alternatives to taking medication?

Sometimes your health problem or long term condition can be managed without taking medication, such as through diet, exercise, quitting smoking, and other lifestyle changes. You can ask your healthcare provider if there are things you can do instead of taking medications. Sometimes those actions work but sometimes they do not and your healthcare provider Learn More >>

How can I get a hospital referral?

For information on referrals – how to find out if you need one and what to do if you are required to have one – please click here. Click here to find referrals to hospitals in your area. Remember to make sure that any hospital you select is in your health plan’s network. Learn More >>

How can I make sure my hospital is in-network?

It is not only important to look at whether your healthcare provider is in your network, but also what hospitals in your area are in-network. Your network is determined by your health plan. The network for one health plan may differ from the network of another health plan. Knowing which network you have and which Learn More >>

What should I ask my doctor about a procedure?

You should always be sure to ask your healthcare provider why you should have a particular procedure, what the alternatives are, and what could happen if you choose not to have the procedure. Being your own best advocate and getting as much information as possible up front is an important part of the healthcare provider-patient Learn More >>

Where can I get more information about a procedure?

Your healthcare provider should have resources available to prepare you for your procedure. You should also contact your health plan as they might have programs and support available for your condition or procedure. There are also many websites that offer information on what to expect regarding your procedure. Click here to see a few of Learn More >>

What determines the cost of a procedure?

If a healthcare provider suggests a procedure, one of the first things you should do is check with your insurance company to see if it covers the procedure, the facility where the procedure will be performed, and all the healthcare providers performing the procedure. Having your procedure performed by in-network providers at an in-network facility Learn More >>

Will my health plan cover a procedure?

Sometimes a health plan will require preauthorization for a proposed treatment plan to determine whether or not it is medically necessary. Check with your insurance plan to see whether preauthorization is required. If so, your healthcare provider will make the request in writing and submit all of the information to your insurance company. If you Learn More >>

Should I get a second opinion, and will my plan cover getting one?

Seeking a second opinion can be extremely valuable, especially if you have been diagnosed with a condition that is potentially life-altering and requires difficult choices about treatment plans. Seeking advice from more than one medical expert allows you to gather more information about your diagnosis and potential treatment plans before making decisions about next steps. Learn More >>

What should I know about patient safety for a hospital-based procedure?

As a patient, it is your job to be an active partner in your healthcare. Before having a procedure, make sure that you understand your medical condition and the medications and procedures used to treat it. If you have a question, ask it. When you are in the hospital, the notes in your charts are Learn More >>

How do I get the best quality doctor or hospital to perform a procedure?

Research which healthcare providers in your area perform the procedure. Once you find the provider or hospital where you would like to have your procedure done, you should: Check to make sure the provider has admitting rights at the hospital; and Check to see that the provider and hospital are considered in-network. If they are Learn More >>

Why might I need to see a physical therapist?

According to the American Academy of Physical Medicine and Rehabilitation, rehabilitation services are often required or recommended if: You had an accident or you have an injury or chronic condition that has left you with pain or limited function; You’re contemplating or recovering from surgery; You have an illness or treatment for an illness that Learn More >>

What are physical rehabilitation services?

Rehabilitation services are often recommended as a non-surgical treatment plan for people who have sustained an injury or illness that impacts the normal functioning of nerves, bones, joints, ligaments, muscles and tendons. Your health insurance company’s website should provide you with a list of physical therapists and rehab centers in your area that are covered Learn More >>

What factors determine the cost of my rehabilitation treatment?

The cost of physical rehabilitation will depend on what plan you have, whether or not you have met your deductible (if you have one), the provider you see, and other factors. Be sure to contact your health plan to determine your specific costs. How many visits your health plan will cover will depend on what Learn More >>

What happens if I have trouble paying my medical bills?

There are a few options. Many people don’t know that medical bills are negotiable. Negotiations can take place through a hospital or provider’s office, or through your insurance company. Check with those sources to see if there’s a way to lower your bill or come up with a payment plan. Make sure you’re prepared before Learn More >>

What are my rights as a patient?

As a healthcare consumer, you have certain rights and protections when it comes to the care and information you receive about your health. Some, such as the right to a copy of your medical records, are protected by federal law and often, states have their own additional laws in place to help protect patient rights. Learn More >>

What are the HIPAA Privacy Laws?

The Health Insurance Portability and Accountability Act or HIPAA, is a federal statute that helps protect the privacy of your health information and gives you control over how your health information is used and shared. Under HIPAA, healthcare professionals and providers (like physicians and health insurers) are required to uphold nationally-recognized standards and follow specific Learn More >>

What is the Patient’s Bill of Rights?

The Patient’s Bill of Rights under the Affordable Care Act guarantees the following: The right to appeal: If you are denied coverage for a particular treatment or service, you have the right to ask that your plan reconsider. Ban on discrimination against patients with pre-existing conditions: Under the Affordable care Act (ACA), no one seeking coverage Learn More >>

How do I appeal a coverage decision made by my health insurer?

If your health insurer denies a claim and refuses to pay for your care or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. Insurers are required to let you know why they denied your claim or ended your coverage. They are also required to Learn More >>

Who can I contact for more help concerning my consumer rights?

There are several resources available that can provide more information regarding your rights. Please see our helpful links page for some of the resources. Learn More >>