Asking the right questions can help you choose the best plan and healthcare provider for you and your family, and can also help you manage your healthcare costs. Use the below suggested questions to ask.
Choosing a health or dental plan is the first step in getting the most out of your care. Every health and dental plan has different coverage, doctors and out-of-pocket costs. Make sure you choose the best plan for you. Remember: dental plans are often separate from health plans. To choose the right plan for you:
Ask Before You Sign Up
Even if you have a health plan, you will still have some costs. Ask your health plan or doctor the questions below to understand how much you will have to pay for the care you and your family receive.
Choosing a Healthcare Provider
If you visit a doctor, hospital, or other healthcare provider that does not take your plan, you may have to pay more. Ask your plan how to avoid or deal with for extra costs:
Ask the questions in the FH Quality Toolkit when you are choosing between healthcare providers.
Visit the Resources Section for tools you can use to find healthcare providers.
Tracking your Deductible
Your deductible is the amount of money you have to spend before your plan starts paying for your care. You may have different deductibles for doctors who take your plan (in-network providers) and those who don’t (out-of-network providers). You also may have a separate deductible for different types of care and prescription drugs. Keep track of all your receipts, and check in with your insurer to make sure their information matches yours.
Make sure any regular medications you take are covered by your plan, and that you know how to get them. For example, some plans require you to use a generic version of medications, or order daily medications in three-month supplies instead of refilling them at your pharmacy.
Before Going Out-of-Network
Are you considering seeking care from a healthcare provider who does not participate in your plan’s network? Avoid financial surprises by doing your homework in advance. Use the helpful questions below when you speak with your healthcare provider and health plan.
Ask Your Healthcare Provider
Ask Your Plan
If you can’t afford care or receive an unexpected bill, you can negotiate the cost or appeal using your FAIR Health cost estimate, which you can obtain on the cost lookup tool. If you have questions about your bill, call your plan first and ask them to explain. Compare your bill to the estimate on this website to see the typical cost of the service in your area. This will help you decide if you would like to pay the full cost, negotiate the cost with your healthcare provider or send an appeal to your health plan if it paid less than you expected. Your plan document should provide information about the plan’s appeal process. Or, you can call your plan and ask for instructions on filing an appeal.
Each medical service, test, and supply you receive has a specific CPT® code, and the price you and your plan pay is based on that code. Knowing that code will make it easier to talk about the service with your plan and your healthcare provider.
Negotiating the Cost of Care with a Healthcare Provider
If you are planning to visit a doctor who does not take your plan, you can use the cost estimate obtained on the cost lookup tool to negotiate the price.
Appealing with Your Insurer
If your health plan paid less than you expected, you can use your cost estimate to appeal.