Author Archives: Diane Reilly

Portals, Passwords, and Patience: Essential Elements for Understanding Your Health Plan

For many of us, the start of a new year brings a host of resolutions and a long to-do list for improving our physical health. One item that should be on that list is to fully appreciate, understand, and utilize our respective health insurance plans. 

Patient Portals / Insurance Portals

Healthcare consumers have become accustomed to using healthcare system portals to make and cancel appointments, request prescription refills, view test results, and even pay bills. 

However, health insurance portals are often underutilized. That’s unfortunate because these can provide a wealth of information, including assistance with healthcare accessibility, a detailed understanding of the terms and conditions of a policy, clarification of benefits, and more, all of which can potentially save thousands of dollars in healthcare costs. 

To access your health insurance portal, simply visit the insurance carrier’s website and register for an account. While this will add one more portal and associated password to what I am sure is already a long list (!), I can assure you it is worthwhile.

The Benefits of Insurance Portals

Above all, using your portal will save you money. Most of us are in plans in which we have coverage and/or pay less if we use a certain network of providers and if we are prescribed prescription drugs that are in the plan’s formulary (list of drugs covered). We may also pay less if we use a free-standing facility rather than a hospital for lab work, X-rays, diagnostic imaging, outpatient surgery, etc. Your portal contains all of this information.

More specifically, your portal can help in…

Finding a provider. Most insurers have defined networks of providers. To determine if a provider is considered in or out of network, or to find a new provider, use the “Provider Look Up Tool.” 

Understanding your prescription drug benefits. Health insurers are required to publish a drug formulary. This helps you know whether a particular drug is covered, how it is classified, and whether there are quantity limits or requirements for prior authorization.

Accessing plan documents. You may have received a Plan Summary or a Guide to Using your Health Plan and a booklet entitled “Evidence of Coverage” (EOC) in the mail along with your ID card when you first joined your plan. These documents are accessible on the portal; it is the place to begin your search for answers when you have a question about how your health plan works in a specific situation. The EOC is the contract you have with your insurer and will be found here, too.

Tracking your deductible. Most health insurance policies have an annual deductible — the amount you must pay out of pocket before your insurer begins to make contributions to your healthcare costs. Tracking this on the portal provides an accounting of what you have already paid out of pocket as well as the cost of upcoming services.

Clarifying Bills. If you receive a bill and don’t understand why, or if it seems incorrect, don’t just pay it! Do some research first. You can see how the claim was processed, helping you to calculate what your out-of-pocket cost should be. If you do need to call for an explanation, you will have good information in hand with which to begin a dialogue. 

Making premium payments. Paying your premium online is fast and easy, saving you the time and money it takes to write a check.

Downloading forms for reimbursement or getting a new ID card. If you are seeking reimbursement from your insurer for services received out of network or out of the country, or for fitness and other benefits, all necessary forms are on the portal. You may also use the portal to request a duplicate copy of your ID card.

Obtaining healthcare information. Many portals provide both information and incentives for managing chronic conditions, such as asthma, diabetes, and heart disease. Phone numbers for 24/7 nurse call lines and what to do in an emergency are often published there as well.

Tips on Calling Your Insurer

If you do not have internet access or are not computer-savvy, you always have the option of calling the customer service line (the phone number is on the back of your ID card). When you call, remember to do the following:

Be prepared to wait. It may require both patience and tenacity to speak with a representative.

Have your information ready. Your health plan ID, member or group number, your date of birth and, occasionally, other identifying information such as your home address or Social Security number.

Know with whom you interacted. Obtain the first and last name of the representative. Make note of the time and date of the call as well. This may be useful later on if there are disagreements regarding the information you received.

Request a “call reference number.” In the event of a misunderstanding or dispute, the call reference number will provide quick access to a recording of the call, helping to expedite resolution.

Help a friend. If you are calling on behalf of a friend or family member, be prepared to have them join the call or submit a form designating you as an “authorized representative.” Health plans must follow strict privacy rules and cannot speak with anyone other than the member or their authorized representative.

Final Thoughts

Although we wish health insurance was simple, it is not. You need to invest some time and effort if you are going to get the most from it. Using an insurance portal for your plan can save you both time and money as the new year begins!