Health Insurance Company Review Guide
For a credible look at reviews, rankings and background information on health insurance companies available in each state, check out Best Company- a site committed to helping users find the 'Best Company' for their needs based on the consumer perspective. Link to Health Insurance companies is below:
How to Be a Smart Consumer
Estimated Cost Calculator-
- Wondering how much a healthcare visit, test or surgical procedure might cost?
Visit the Fair Health Consumer Link
“Fair Health is an independent non-profit organization that collects data for and manages the nation’s largest database of privately billed health insurance claims”, according to their website.
Committed to empowering consumers, their website offers various data products, tools and educational information that makes health care more transparent and easier to navigate through. Most notably is the Fair Health Consumer estimated cost calculator. Anyone wondering about the cost of a medical service before a claim has been processed is typically out-of-luck. Now, with the help of Fair Health Consumer’s cost calculator, estimated medical and dental costs can be reasonably estimated ahead of time. If you’ve heard our menu-without-prices analogy before, this tool is the closest thing you’ll get to finding a price before the meal is served!
Note: For any medical test, procedure and/or services performed. Ask your provider for the CPT(Current Procedural Terminology) codes being used. Give them to us and we'll show you what an appropriate price should be.
- For even more transparency, turn to the American Hospital Directory providing data, statistics, and analytics on more than 7,000 hospitals nationwide.
- Talk to us and we'll teach you how to grade hospitals based on analytical measures that actually grade the quality and cost of care. We can even break it down based on medical condition(cardiology, neurology, orthopedics, etc).
Needymeds.org (Save big on Rx Costs)-
- Need help paying for expensive prescriptions? Needy Meds might be the resource for you.
“NeedyMeds is a national non-profit organization that maintains a website of free information on programs that help people who can’t afford medications and other healthcare costs”. They provide direct assistance and facilitate programs that help consumers like yourself. For financial assistance on expensive prescriptions, follow this short step-by-step guide:
1) Go to needymeds.org and find the drug search box to the left of the screen
2) Type in the name of the drug your looking for financial assistance on
3) Search and scroll down to find the official prescription name and dosing type
4) See and Click the icons that appear, representing the different savings modes
5) ‘Prescription Assistance Programs’ and ‘Coupons, Rebates and More’ icons are the applicable ones. Clicking either one of these will bring you to the list of cost savings programs available.
- Also available is a free drug discount card (small fee charged for every utilized service) and pharmacy comparison Rx tool, among other time and valuable cost-saving information.
Preventive Benefit (ways to save with free preventive measures)-
The United States Preventive Task Force is an independent panel of medical experts in the prevention of disease and evidence-based medicine. Their recommendations on the need for clinical services is broken down into letter grades. All A and B graded services are free for people with ACA-compliant plans.
- All A and B graded services are free: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/
Surprise Medical Bills-
Quite often, people come across something called ‘Surprise Medical Bills’. Essentially, these bills are directly administered by the provider or claims processor to you, instead of first through your insurance company. Reason being, the providers involved are out-of-network only, meaning they don’t accept the reimbursement terms of your insurance plan. This means you could be balanced billed, owing the remaining reimbursement your insurance company doesn’t agree to with the medical provider or worse, be charged the entirety of the provider bill. If you find yourself in this situation, as many people have including myself, DO NOT PAY IT!
As of September 1st in New Jersey, this practice has been legislatively addressed.
Here’s the result: Any out-of-network provider who performs service at an in-network facility must:
1) Inform the Patient Ahead of Service OR
2) Accept the state-mandated in-network reimbursement fee and the patient owes what the Summary of Benefits state for the type of service rendered
How to Read a Health Plan
How to Read a Health Plan
If you’re reading the summary of benefits for the health plan you’ve elected, sometimes the terminology can be confusing. Here’s a video explanation that might help:
What is a Co-Pay, Co-Insurance and Deductible-
What is MOOP or Maximum-Out-Of-Pocket-
Utilizing the Right Healthcare Facilities-
Knowing some basic information about the differences in costs between healthcare facilities can end up saving you hundreds, if not thousands of dollars per claim! Surprisingly, despite the simplicity, many people are either unsure or unaware of this, receiving healthcare services without knowing a few basic things first:
Emergency Care: Urgent Care Center vs. Emergency Room-
If you need immediate medical attention, Urgent Care Centers and Emergency Rooms are available for this purpose. But how do you tell the difference?
Severity of Injury:
Urgent Care Center- Designed for NON LIFE THREATENING situations and MINOR PHYSICAL INJURY. Most are open late, including weekends and holidays. Here are a list of conditions Urgent Care Centers are designed to treat, but not limited to:
- Ear Problems
- Illnesses such as mono or bronchitis
- Localized severe pain
- Urinary tract or yeast infections
- Symptoms of discomfort such as skin, stomach or throat problems.
Emergency Room- Designed for LIFE THREATENING situations and MAJOR PHYSICAL INJURY. Most are open 24 hours, 7 days a week.
Here is a list of conditions emergency rooms are designed to treat, but not limited to:
- Severe bleeding and lacerations
- Broken bones or bad dislocations
- Any kind of mental disorientation
- Severe chest pain
- Severe difficulty breathing
Use your own discretion! If you aren’t sure how serious the situation is, err on the side of caution and use the Emergency Room.
Although you shouldn’t let costs deter you from using the emergency room when the ailment is serious enough, it’s always important to know. When an emergency is appropriate for urgent care use, the cost savings is substantial. From a cost perspective, here are some things to know:
- ALWAYS MAKE SURE AHEAD OF TIME IT’S AN URGENT CARE CLINIC- just because the clinic is in a separate location from the hospital (i.e. freestanding emergency rooms) doesn’t mean it’s not affiliated with a hospital. If possible, make sure ahead of time. Emergency room care is usually subject to a deductible first. Urgent care centers typically charge co-pays. For the consumer, knowing this difference can save hundreds of dollars on an emergency visit.
Radiology: Free Standing Clinic vs. Office vs. Hospital-
If you need Imaging or Radiology work done, know your choices of facilities.
Free Standing Radiology Centers are cheaper than Hospital-Affiliated Centers
Generally, having radiology work done at an outpatient facility, NOT tied to the hospital, will lower the cost of your claim, thus allowing you to pay less money. If you need any pre-authorized diagnostic imaging work done, always use a free-standing or independent radiology facility. In a survey comparing seven procedures, Regents Health, a medical imaging consultancy, found the hospital expense on average was $85.78 while the freestanding imaging center averaged $69.33. And that doesn’t include the extra costs associated with hospital overhead.
Out-Patient Surgery: Ambulatory Center vs. Hospital-
Ambulatory Surgery Centers are sprouting up more than ever these days. This isn’t unusual since it helps lower healthcare costs and likewise, is encouraged by insurers. So how should you know whether an Ambulatory Surgery Center is right for you? For typical non-life-threatening surgery, such as joint replacement surgery, an Ambulatory Surgery Center might provide cost-savings. Ambulatory Surgery Centers were originally designed to open up surgery backlogging faced by hospital units.
Talk to your doctor ahead of time about the possibility and costs associated with using an Ambulatory Center.
Health and Wellness Benefits
Health and Wellness Benefit
The utilization of Health and Wellness programs incentivizes people to participate in programs such as:
Weight loss management
Preventive health screenings
Most often, Health and Wellness programs are offered alongside employer health insurance as a means to keeping employees healthy. Healthier employees means lower premium costs. In return, employees can take advantage by utilizing discounts and deals offered by these programs to encourage a healthy lifestyle.
Elevate Wellness Programs/ Union-Association-
- Download My Health Coach Now for fitness information or UPGRADE for My Health Coach Now Healthy Rewards.
- Upgrading to My Health Coach Now Healthy Rewards allows you the potential to earn financial rewards and gift cards up to $200.
Apple Watch Benefit/ Self-Funded-
- Certain self-funded employers might be eligible for a discounted Apple Watch, as low as $25 and their enrolled spouses may do the same for as low as $50.
- Apple Watch Series 3(GPS + Cellular- means adding phone line) requires an iPhone 6 or later with iOS 11 or later.
- Apple Watch Series 3(GPS) requires an iPhone 5s or later with iOS 11 or later.
- Apple Watch Series 1 requires an iPhone 5s or later with iOS 11 or later.
How to use the Apple Watch? See this instructional video
Peerfit Group Classes/ Self-Funded-
- Create an account with Peerfit and sign up for participating group classes free-of-charge. https://peerfit.com/register
- What is Peerfit and How Does it Work Link
- To search participating studios, click the following link.
Fully-Insured Wellness Benefit/ Fully-Insured-
Blue 365( Horizon BCBS members)-
- Blue 365 offers access to health and wellness deals exclusive to Horizon BCBS members. https://www.blue365deals.com/browse-all-deals
- Qualify on discounts for everything from:
Lifestyle and Wellness