Health insurance is an integral component of overall wellness planning, so let’s cover some basics to help you choose a policy that suits you and your individual needs.
Connie Millecam received an unexpected letter from her insurance provider that could bring drastic changes to her healthcare. At age 80, this Salt Lake City woman relies on a pacemaker for treatment at U of U Health physicians.
In-Network
The University of Utah Health system is an acclaimed academic health care center, serving over 5 million people across five states and more than 10 percent of continental United States. Renowned for medical innovation and compassion, its hospitals include Huntsman Cancer Hospital and University Neuropsychiatric Institute which are consistently rated in the top 10. It takes pride in serving its community by offering excellent care at every point of contact.
In-network healthcare services are provided by healthcare providers who have signed an agreement with your insurance carrier to offer treatment at a set cost. These agreements can usually be negotiated between healthcare provider and carrier. By accessing in-network healthcare services, out-of-pocket costs are reduced while budgeting can also become easier.
Your health plan’s website can help you locate in-network providers. Some plans offer coverage across all states while others only list providers in certain states – if your health plan only covers providers in Utah, use the Utah provider directory to see who is covered there; alternatively, check your member portal to determine the national network that covers you.
Utah health insurance options include traditional employer-sponsored group coverage, individual marketplace plans and the Affordable Care Act Marketplace (ACA Marketplace). ACA Marketplace provides financial support through premium tax credits and cost-sharing reductions to help reduce healthcare expenses for individuals and families of varying income levels, so anyone can purchase Utah health insurance through it.
Connie Millecam of Holladay has Regence insurance through her job and is an ongoing patient at UUH’s Huntsman Cancer Hospital. Recently, Regence informed her that Huntsman may no longer be covered under her Medicare Advantage plan without an agreement being reached between both groups; Millecam expressed concern that she will no longer receive the treatments she requires without UUH specialists being part of her healthcare. They advised Connie to reach out directly to Regence.
Out-of-Network
Health insurance plans are contracts between an insurer and members that grant access to healthcare at certain rates, whether provided by private companies or governments. Their cost varies based on type, provider, coverage and benefits such as copayments, deductibles and out-of-pocket maximums; plans can be obtained via employers, private companies and the Affordable Care Act Marketplace website for comparison shopping purposes.
Utah residents looking for affordable health insurance can access coverage through the Affordable Care Act Marketplace. Individuals whose earnings exceed what is eligible for Medicaid can still receive financial help in form of premium tax credits and cost-sharing reductions; other low-cost health plans available include Medicare Advantage plans and the Children’s Health Insurance Program.
Utahns depend on the University of Utah Hospital to treat life-threatening injuries and illnesses. As one of the nation’s premier academic health systems, its leaders are dedicated to providing their patients with top-quality care. Renowned for innovation, education, research, community engagement and employee and student dedication – it offers world-class care across its network.
U of U Health Plans offers several group product offerings: PPO, EPO, HSA and QHDHP. While members have the freedom to select any doctor or facility they like within UUHP’s network providers for PPO plans, more cost-effective providers are found through network providers with UUHP’s protocols in place to detect overutilization or underutilization or quality-of-care issues that need addressing.
UUHP is dedicated to providing timely and thorough utilization review processes for all claims. If a patient disagrees with a decision from their physician or health insurer, they can appeal with the independent external review (IRO) department and request for review of their claim by them. Upon receipt, an IRO representative will review it before providing their decision – which members can request through either their UUHP account representative or calling the customer service number listed on their Member ID Card.
Deductibles
The University of Utah Hospital accepts many different health insurance plans, such as Medicare, Medicaid and private policies. Individuals and families may also enroll in an Affordable Care Act Marketplace plan to receive financial assistance for low-income individuals and families.
Patients enrolled in plans with deductibles are responsible for covering some medical expenses before their insurance kicks in, while some plans feature coinsurance – in which the patient pays part of their bill while insurance pays the rest – or an out-of-pocket maximum which specifies how much will need to be paid within an annual time period.
Utah residents can use the Affordable Care Act Marketplace (ACA Marketplace) to find an insurance plan that meets both their needs and budget. There is a selection of traditional plans as well as HSA-qualified plans which enable policyholders to contribute money toward an HSA account.
Michael Good is CEO and executive dean of University of Utah Health, a world-class academic health system known for its innovation, research, education, and community engagement. Under his guidance, the organization has seen remarkable growth with new facilities popping up all across campus and community as well as transformational initiatives being put into effect.
Prior to joining the University of Utah, he served as vice president of Mayo Clinic where he oversaw clinical, operational and strategic leadership initiatives.
Utah Medical Group providers are in-network providers for many insurance providers, such as University of Utah Health Plans, Regence Blue Cross and Blue Shield and Intermountain Healthcare’s Physician Network. Furthermore, SelectHealth STAR members have access to services provided by UTAH MEDICAL GROUP providers.
Katie Pollard of Salt Lake City is worried about what will happen to her health insurance next month if University of Utah Health and Aetna cannot reach an agreement on health plans. Aetna sent an email informing her that the health system would no longer be part of her plan’s network, meaning if she wants to keep seeing the physician who performs pacemaker implant surgery she must either switch insurance providers or go out-of-network.
Copays
Most health insurance plans include a deductible that patients must meet before coverage commences, after which copays are applied towards each visit or service provided, helping keep costs under control for both patient and insurer alike. It is essential to be familiar with all charges before selecting an affordable plan.
SALT LAKE CITY — Vivian Lee’s question may appear unusual in medicine, yet most businesses know exactly how much it costs them to produce the goods and services they sell. But hospitals have difficulty pinpointing their own service costs accurately — an issue which must be overcome to set prices accurately and attract new customers.
Since 2013, University of Utah Health’s Chief Executive Officer, Jennifer Lee has been asking this question at her hospital and clinics. Now she is seeing answers that have captivated institutions ranging from Harvard to Mayo Clinic as well as Secretary of Health and Human Services.
Hospital costs have been cut back at MD Anderson Cancer Center of Houston by closely scrutinizing each process involved in treating patients, from how much time physicians spend typing notes to analyzing supplies used on each task. They’ve also started tracking supplies used frequently in emergency departments instead of writing notes themselves and hired lower-cost scribes instead of doctors doing it themselves in emergency departments – “we’re trying to bend the curve,” explained Dr. Thomas W. Feeley, chief medical officer.
At the UofU Student Health Center, it’s important to find out exactly which services your insurance plan covers before scheduling an appointment. Some plans only bill when an enrollment card is presented at time of service while others only cover services received from providers within their network.
Many Americans struggle to afford healthcare in the US. If this sounds familiar to you, most hospitals provide charity care programs to alleviate their bills for families making less than $100,000 annually. You can apply online or over the phone in minutes; customer service representatives at many hospitals also are on hand to answer questions and guide applicants through this process.
