What to Look For When Signing Up for Health Insurance

The 2018 open enrollment period for the healthcare marketplace ends after December 15, 2018.

As the parent of a child with hearing loss that has been forced to get new health insurance every year for the last seven years (our plans were “no longer offered,” i.e., cancelled, each year), I understand how hard it can be to choose a health insurance plan. If possible, work with your employer’s human resources department to pick a plan. For the rest of us without that option, here are a few tips to consider when choosing an insurance plan for you and your family. There are additional resource links at the end for more tips.

Tips for Choosing a Healthcare Insurance Plan

Understand the plan you currently have: know what is covered now so you can search for something similar or for better coverage.
Check on your healthcare providers: call each plan you are considering to make sure your doctor or provider will be in network for the next year. Each year many doctors and hospitals drop more and more insurance plans. Be careful to make sure your plan is still in network for them. Also, call your regular doctors and healthcare providers billing departments to cross check they will be considered in network for your new plan.
Run the numbers: Carefully consider not just the monthly cost of the plan, but also the in network and out of network deductibles and copays. By looking at the overall out of pocket possible, you may find a higher monthly premium will end up being a lower cost over the entire year. The Summary of Benefits and Coverage for a plan being considered should show examples of how much you may be out of pocket in different treatment situations (actual costs will likely differ but they do help explain how deductibles, copayments, and coinsurance fit together for the plan).
Compare costs: If you have regular treatments or tests done, consider searching for a lower cost option through FAIR Health, Clear Health Costs or Healthcare Bluebook. Your healthcare provider may not have the lowest cost.
Stay organized: By having clear and complete records, you will see where your current healthcare costs are the highest and where a change in a future healthcare plan could help your finances. Keep binders or other organizational filing methods to sort bills, tests, emails, records of phone calls to insurance, calls to hospital billing/insurance departments and healthcare providers and all insurance papers.

NOTE: Staying organized will also help you manage your current healthcare expenses. Bills are also not static. Often hospitals and provider offices incorrectly code the medical treatment or visit. Hospitals and provider offices will also wrongly submit a claim as in network when it is actually out of network or visa versa. By incorrectly submitting a claim, the billing process is delayed causing problems with paying on time, which can lead to collection agencies unless you keep on top of the billing department. By having clear records, you can wait patiently to pay your bill until it has been properly put through the claim process. Also, consider the appeal process. Look at your specific healthcare insurance’s information on appeals and carefully follow the directions. If all else fails, ask for a peer to peer appeal and get your doctor directly involved. Your state may also offer a free outside appeal process if you have reached the end of the appeal process of your insurance company (we were able to get our daughter’s first cochlear implant approved through the external appeal process overturning the insurance company’s decision).

Consider a broker: Healthcare Insurance brokers may offer more solutions than you have access to depending upon where you live.
All is not lost if there is no insurance that is completely satisfactory, negotiate with your healthcare provider for better rates: If you cannot get in network insurance for any healthcare providers that treat your specific diagnosis, consider negotiating with the hospital or doctor’s office for an out of network rate which can lower the cost 20% or more. Go directly to the highest level of billing to avoid wasting your time. Stay strong (dealing with hospital billing can be as backbreaking as dealing with insurance) and keep asking until you reach them. Taking the time to communicate over the phone, email or in person with billing departments and your insurance company can fix improper billing and incorrect claims. Most important, keep good notes of every communication.

For all Illinois families with kids with hearing loss: See the FHSR Blog post on the new Bill passed to cover pediatric hearing aids. Also, as far as we can tell research hospitals, including all major pediatric cochlear implant departments in Chicago, Illinois, are not considered in network for any Illinois Marketplace offered Healthcare Insurance Plan for Individuals/Families. If you are forced to use the Marketplace, start talking to your cochlear implant team about it immediately.

Finally, after you’ve selected a new provider, keep your healthcare providers up to date: As soon as you switch healthcare plans, contact all providers and their business offices to let them know what new healthcare insurance you have. It is much better to worry about delivering information when you are healthy, than during an emergency or illness.

Choosing the right Healthcare Insurance Plan is a task that involves understanding what is best for you and comparing it to the options available. I wish it were easy and pleasant, but it is not. By taking the time to learn what you currently have, what you actually need, and what is available, you can save yourself the pain of insurance nightmares over the next year.