The start of a new year brings resolutions, feelings of brand new beginnings, and a fresh start. Sometimes, it also creates changes in your health insurance coverage. Many companies reevaluate their health insurance coverage on an annual basis, and insurance providers often revise plans. So what do you do if your health coverage changes? We’ll walk through some common questions about coverage, including some tips, and what you can do to prepare for any health issue that arises.
Common Health Coverage Questions
When it comes to health insurance, there are a lot of questions that come up, especially if your coverage has changed. We've broken down some of the most common questions into three categories: providers, prescriptions, and emergencies.
Providers are usually the number one subject when it comes to changes within healthcare insurance plans. When your coverage shifts, here are some answers to the most common provider-based questions.
- Will I be able to go to the same provider?
Most insurances have what’s called “in-network” providers. These providers have contracts with insurance health plans, and while you’re able to visit other providers who are not in-network, they may have higher out-of-pocket charges. Check with your policy as some plans also offer patients to see an out-of-network specialist at in-network rates if a primary care provider gives a referral.
- How do you find a provider in your health plan?
There are a few steps you can take to find which provider your health care plan covers.
- Check out the provider directory on your healthcare plan's website.
- Contact your insurance company and ask.
- Contact your provider and ask.
- I don’t know the number for my insurance company?
Double check with your employer to see what insurance company offers your coverage and the specifics of your plan. Once you know who you have as your insurer, you’ll be able to find information about what providers in your area you can visit.
- Is my plan covered by North Clinic?
North Clinic accepts most major insurance plans. Please see our list of insurance carriers.
Health care plans often cover a variety of medicines, but when your coverage changes, your prescriptions might also. Here are a few questions, regarding medications, you might have when changing plans.
- Are you still able to buy other medications?
Yes, while certain prescriptions are usually on your health care plans' approved list, sometimes there might be a medication that is no longer covered by your new plan (whether it’s a brand name or generic). You should still be able to buy the medication that you want, but it may be at a higher rate or cost more out-of-pocket than any of the options on the approved list. Contact your insurance, review coverage materials, and summary of benefits to find what is accepted for your plan.
- My pharmacy says my plan no longer covers my prescription pick-up, what do I do?
Depending on your insurance company, they will decide where you’re able to get your prescription from, but most will also offer a one-time refill after changing your coverage. If you’re not able to get that one-time refill, you can discuss next steps with your provider. You may want to consider following your insurance company’s exceptions process. It's recommended to contact your company for information about their exceptions process.
- My exception process was denied, now what?
Most health insurances have an appeals process where the decision can be review by a third party if you were denied your prescription.
- Does my pharmacy change with my insurance coverage?
Look on the website of your insurance company to find in-network pharmacies near you and what companies offer home deliveries in your area.
Accidents and emergencies can happen, here are a couple common questions people have regarding their insurer and hospitals.
- I’m experiencing an emergency, do I need to call my insurer before going to the hospital?
No, if you’re in a life-threatening situation or dealing with a severe illness or injury, please seek attention at your nearest emergency room or hospital. Insurance companies can’t request prior approval before you find medical care with a provider.
- I went to an out-of-network hospital for an emergency, will I be charged more?
Whether you go to an out-of-network or an in-network hospital, insurance companies can’t make you pay more in copayments. While copayments might be different between in-network and out-of-network hospitals and providers, this should be listed in your plan.
- What if you are on a plan without co-payments?
You will pay out of pocket, but only up to your out pocket maximum.
North Clinic Makes It Easy To Get The Healthcare You Need
While we may not accept every healthcare plan, we do have a long list of insurers we work with as well as different types of programs for those who are non-insured. We also provide monthly payment plans like PrimaCare Direct for those wanting to access healthcare without having to deal with copays and deductibles.
Whether your insurance changes or not, we’re ready to help with your healthcare needs throughout the year. Schedule an appointment with your provider or try our new walk-in appointments currently available at one of our three locations: Maple Grove, Osseo, and Plymouth.
Have any additional questions about your health or not sure what to ask your provider? Check out our free guide below!