Content Overview
- Summary
- Keep Track Of Out-Of-Pocket Medical Expenses
- Keep Your I.D. Card With You In Your Wallet Or Purse
- If You Have A Choice, Balance Premiums, Deductibles, Co-Insurance, Stop Loss And Benefits
- Minimize Out Of Network Costs. For example, if You Agree To Surgery, Make Sure All Members Of Your Surgical Team Are Part Of Your PPO.
- Negotiate Fees With Out-Of-Network Health Care Providers
- Avoid Paying Money In Excess Of Usual, Customary And Reasonable
- Think Of Case Managers As A Resource
- Stay On Top Of Insurance Company Reimbursements
- Be An Informed Consumer When Purchasing Drugs, Tests Or Treatments.
- If You Smoke, Quit.
- If You Need An Off Label Or Experimental Treatment, Work With Your Doctor To Get Coverage
- Don't Accept A "No" From The Insurance Company.
- How To Choose And Maximize Use Of Doctors And Specialists
- Take Advantage Of Your Plan's Mental Health Benefits
- How To Keep Your Doctor When You Change Health Plans
- Insurance Policies Are Not Set In Stone.
How To Maximize Use Of A PPO Health Insurance Policy
If You Have A Choice, Balance Premiums, Deductibles, Co-Insurance, Stop Loss And Benefits
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If you have a choice about features of your policy, it's not easy to foresee how to reach the best balance of premium amount with benefits, and amount of deductible, co-insurance and stop loss.
- Increasing the amount of the annual deductible
- Increasing the amount you pay as co-insurance
- Increasing the annual stop loss
- Decreasing the benefits
If you think about insurance as a way to pay for unacceptable medical expenses, then it becomes clear that saving dollars now to decrease a lifetime maximum becomes really risky.
With a history of a life changing condition, it seems likely that you will incur a basic amount of health care expense each year. You can pay an insurance company to cover those costs. However, trading dollars with an insurance company is expensive. If you pay the medical costs directly, it only costs you $1.00. On the other hand, if you want the insurance company to pay, it will cost you $1.00 plus money to cover the insurance company's overhead, administrative costs, and profit.
The amount of co-insurance that works best for you relates to the amount of the stop loss, which in turn depends on the amount of money that becomes an unacceptable risk to you.
The balance becomes even more difficult if you are part of a unit with a spouse/significant other and/or children.
An experienced insurance broker or financial planner can help you figure out the balance for your life.
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