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. 

 

 

Cost Difference:

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.