Many individuals are confused as to whether they possess health insurance coverage. Your insurance card should tell you this information – usually including information like the enrollee name, member ID number and policy number.
Each individual covered under their plan has their own policy number that can help medical providers quickly access relevant data.
1. Look at Your Insurance Card
Insurance cards are one of the best tools you have at your disposal to understand your coverage, where to go for care, and any costs that might incur. When enrolling in a plan during open enrollment or any time afterwards, these cards will arrive either digitally or by mail – also serving as proof that healthcare costs are accurate.
Your insurance card contains personal details about both you (if you are the policyholder) and those covered under your plan ( if they are). It will typically feature information such as member ID number, name of insurer, plan type/group number(s), plan name/number(s), group number(s) etc. depending on your individual circumstance.
Health insurance cards often display the name and contact details for your primary care provider (PCP). Since some plans require selecting and receiving referral from a PCP before visiting specialists, keeping this information close is helpful. You’ll also want to look out for your benefits such as prescription drug coverage (Rx symbol) and out-of-pocket costs such as deductibles or coinsurance costs (DOP/COIN symbol).
Trying to understand how your plan works or unsure when enrollment ended? Check your Marketplace account! You will be able to see details such as coverage selections and limits as well as when you signed up. In addition, a Plan Coverage Summary should arrive via email or Marketplace account with all the pertinent details about what coverages were selected as well as any special rules or limitations that apply.
2. Check Your Plan Summary
The Affordable Care Act mandates that all health insurers provide consumers with a Summary of Benefits and Coverage (SBC), an informational document designed to enable comparison between plans without having to read all the fine print. In addition to listing costs of common procedures and visits, as well as cost sharing provisions and coverage limitations, this tool helps consumers make fair comparisons during open enrollment or switching insurers.
Each SBC provides a table titled Common Medical Events that details the cost of common procedures and visits within each plan, after meeting your deductible. Each column in this table should clearly state your post-deductible payment obligation; look out for any tables with exceptions columns as this will give an idea of which services may not be included. In addition, SBCs include sections detailing minimum essential coverage standards as well as value standards applicable to each plan.
To better assess which insurance company may best meet your needs, the NAIC Consumer Insurance Search website can be helpful. Here you can view closed, verified complaints against each provider as well as financials and premiums written within the past three years.
3. Call Your Insurance Company
If you have queries regarding your coverage, it’s best to reach out directly. When speaking with an insurer representative, make sure all documents and cards related to your situation are handy; remain calm and polite as this will allow them to understand more effectively your circumstances. Remember: screaming will not help your case and could force them to disregard what concerns are brought up to them by the representative.
Keep a thorough record of all communications with your insurer, according to Brad Cleveland, an Idaho consultant on customer strategy and management. Document the date, time, name and employee identification number of everyone with whom you communicate along with main issues discussed during calls – then follow up by writing or faxing back detailing this conversation as necessary.
Your insurance card should contain the phone number for your insurer; use this contact info to ask any queries about your plan or receive answers to frequently-asked-questions (like how to pay bills or when coverage starts and ends). In addition, there will likely be a list of doctors and hospitals included as “in network” providers – many health care providers will even contact them on your behalf prior to scheduling appointments for verification of coverage purposes.
If you don’t currently have health insurance, it is wise to explore your options. Marketplace plans offer eligibility assessments; or contact a SHINE counselor in your area for information about public programs offering reduced-cost coverage options such as Medicaid or Medicare.
4. Ask Your Health Care Provider
Your healthcare provider should maintain a copy of your insurance card on file. Doctors usually make copies the first time they meet you as a patient and at subsequent visits if requested; these cards contain important details, including your coverage type, deductible amount, provider network membership list as well as contact info for doctors who participate. In New York state law requires providers to give this information upon request (though this law doesn’t cover all types of coverage).
Be sure to regularly contact your healthcare provider and verify they remain part of your plan’s network. In-network doctors typically charge reduced rates due to pre-negotiated agreements with insurance providers; out-of-network doctors could increase costs significantly, even for routine procedures.
Your insurance card typically contains a phone number you can contact for more information regarding your coverage, or you can reach out to the commissioner of insurance in your state for any inquiries into how your insurer operates and whether you may qualify for certain federal protections.
Ask friends and family who already have coverage to suggest an insurance provider or plan. They could give insight into a provider’s customer service reputation or ease of website navigation or filing a claim. It’s also important to think carefully about the coverage level you require when choosing an individual or family plan; plans typically fall into two categories when categorised according to coverage; these plans can be found through Health Insurance Marketplace plans (platinum, gold and silver) while bronze catastrophic plans can also be purchased directly.
5. Check Online
People often have access to online portals or mobile apps that enable them to verify their insurance coverage, making this particularly helpful when operating a company vehicle or hiring contractors who require proof of coverage. Most such websites will allow users to see basic details like policy/group numbers, name of policyholders and coverage details.
Plan materials provided through the Affordable Care Act’s Health Insurance Marketplace usually include next steps on how and when coverage will begin. They should also contain contact numbers for their Member Services team who will be trained to answer questions about what your plan covers and how best to utilize it.
Many payers also offer phone lines dedicated to provider support. This can be an efficient way of verifying patient insurance information if the patient is hospitalized or officebound and you cannot reach them directly. But before calling it is essential that all relevant details from your patient, including name, date of birth, insurance number and any relevant employer/insurer ID information is available before making your call.
Gaining accurate insurance information from patients can feel like an intricate game of telephone. While you may receive accurate information from them, if it does not match up with what the payer has on file they could reject your claim and cause unneeded complications in payment for your services and care for patients. To prevent this situation from arising it’s essential that you take the time and care necessary in verifying coverage prior to submitting any claims so both you and your patients receive what is owed to them.
