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Navigating Health Plan Referrals and Prior Authorizations
Why do insurance companies require approval in advance of paying for certain medical treatment? Why would my primary care physician need to provide a formal referral in order for me to visit a specialist? Health insurance plans may include a myriad of checks and balances to ensure the medical appropriateness of treatment before paying on a claim. While insurance companies approve the vast majority of prior authorizations they receive, do they really help to control costs? Evidence suggests a high level of burden is placed upon healthcare providers and patients alike when referrals and prior authorizations are needed which can delay or forgo treatment altogether. This podcast explores these questions and helps to put referrals and authorizations into perspective. Four basic tips are offered to help you manage referrals and authorizations which can impact whether your treatment is approved and covered by your insurance plan.Visit www.maximizehealthinsurance.com to learn more about how to increase your health insurance literacy.
How to Choose a Health Plan
Whether during the annual open enrollment period or a qualified life event, people are offered the opportunity to choose a new health plan but they don't have a game plan on how to evaluate and choose plan that's right for them. Choosing a health plan requires one to make a quantitative and a qualitative comparison. On the surface a health plan may seen attractive because certain features seem appealing. Under the hood a health plan may end up costing you more money or deliver less health coverage than you expected. This podcast covers simple strategies you can use to make an informed decision when offered health plan through an employer plan or a marketplace plan. Visit www.maximizehealthinsurance.com and click on the Resources section to download supporting material that covers information covered in this podcast to hepl you develop your comparison strategy.
Denied Claims: What can you do about them?
Based on data furnished by health insurance plans, an average of 18% of claims are denied. Why so many? In a perfect world, all of our medical treatment and prescription claims would be covered by our health insurance plan. However, Kaiser Family Foundation's review of claims data furnished by over 140 health plans who cover individuals through Healthcare.gov plans found a different story. Medical necessity, contractual reasons, lack of authorization or referrals and eligibility gaps are common reasons why claims get denied. But did you know that administrative or clerical errors cause the most types of denials? And only 1/10th of 1% of claims are even appealed. This podcast takes a closer look at these denial reasons and serves up some action items you can take to protect yourself against paying for denied claims. Go to www.maximizehealthinsurance.com to find resources and other supporting materials discussed in this and other podcasts.
Top Five Health Insurance Literacy Skill Sets
What are basic fundamental health insurance literacy skills everyone must have to navigate their health insurance successfully? Health insurance literacy can be learned enabling you to understand and make informed decisions related to your health insurance. Learn about five basic skills sets that can help you evolve and manage even more complex situations your health insurance may provide. People need to be self-reliant, self-sufficient when it comes to managing their health insurance. We can't expect doctors, employers or the health insurance plan to resolve our questions. Having these foundational building-block skills sets in your back pocket will help you be a more engaged, proactive consumer of your health insurance.
The Business Case for Health Insurance Literacy
What is health insurance literacy and why is it even important to have? This podcast takes a high level view of why health insurance literacy matters. Why are so many people making poor decisions related to their health insurance? We'll explore a number of alarming statistics that illustrates areas of low health insurance literacy and the potential impact it can have on our health care and health insurance decisions.