INSURANCE AND MONEY

Click here if you do NOT have insurance

Insurance is also complicated.  Like everything else, it pays to be prepared ahead of time to avoid surprises.

Here is a quick checklist before we get into details:

1. Open Enrollment - usually November through 1/2 December - get signed up.
1. for both market and employer med insurance
2. eligible life circumstances allow you to obtain/change your insurance in the middle of the year
3. are you eligible for State medical programs, such as Medicaid? States are different and have different programs from one another.
2. Know what all the gobbligook - technical - terms mean with this glossary.
3. Especially, get familiar with "networks," "in-network," "our-of-network," "deductable," "max out-of-pocket," "co-pay," "co-insurance."
4. Know the phone number for customer representatives and call them when your doctor recommends a new treatment or medication - is it covered by your insurance?
5. Know the phone number for your doctor's/clinic's business personnel to get financial information about your treatments.
6. Understand "prior authorizations." Talk to your doctor, doctor's billing/medical records, clinic about whether they will take care of prior authorizations or you have to.  Call your insurance company anyway to talk about the new treatment or medication.

Here is a video explaining basic insurance concepts and how it works for you:
Click the video to get it started
Remember, hover over the video to find the icon to enlarge it.
Press your Esc key to get back to small size

from Nemours: https://www.movinghealthcareupstream.org/


Insurance Explained In More Detail - Kaiser Family Foundation

Kaiser Family Foundation

Glossary of Med Insurance Words
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Medicare Assistance: State Health Insurance Assistance Program (SHIP)
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Interesting Observations about Med Insurance and Paying for Our Healthcare
1. Paying for our medical bills is a very real problem
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American Association for the Advancement of Science

2. You're Insured But Still Owe A Lot of Money
You're Insured But Still Owe $109,000
Surprise Medical Bills
Protection For Surprise Medical Billing

How to Appeal Surprise Medical Bills - In Minnesota
This video is from TV Kare-11 in Minnesota

Other Possibilities for Primary Care Services
Direct Primary Care DPC - Not an insurance

• COST: This is primary care services for a flat monthly fee of about $50-$100/mo and does not accept insurance payments.  Your medical insurance does NOT cover this cost
• CONTINUE WITH MED INSURANCE: You need to carry major medical insurance for specialist medicine and do the math to see if it saves you money, fits your needs.  This is a new healthcare delivery model (past decade) and not well known except to current patients and physicians with this practice
• BENEFITS:
• a patient has more access, faster access, for primary care than a regular office/clinic that accepts insurance payments
• more time with the physician

Descriptions of Direct Primary Care:
1. The Value of Direct Primary Care
2. A Business Take on Direct Primary Care

What else can you do to manage your money and healthcare:
- Search the internet for national organizations

These organizations often have programs that provide financial help - it may be modest but it helps
They may be able to refer you to other, larger organizations that can offer more help paying for care

- For help with expensive, specialty medications
Search the pharmaceutical company that sells the medication (have to talk with pharmacist to get the correct company)

Pharmaceutical companies often have financial help for new medications or re-indicated medications. The pharmacy at a hospital or large organization should already have a relationship with the companies and may have already made a contract with them.  For smaller organizations, you can contact the "Patient Support Programs" yourself at the pharmaceutical company.

Here's an example of a company's patient support program: Incyte Patient Support offers financial help

Click here if you do NOT have insurance