How to Navigate Health Insurance

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Communicate

Before surgery, rehab, or other procedures, talk to your insurance company to find out what is covered. Follow the rules and preauthorization requirements. Check that all the professionals you encounter are covered in your health plan. “You need to read the fine print to see if you need to take steps before procedures,” Shearer says. “You don’t want surprises later.”

Don’t be rushed into an available slot for a procedure. Most procedures are not that urgent, says Carolyn Clancy, M.D., a physician and director of the Agency for Healthcare Research and Quality (AHRQ) within the U.S. Department of Health and Human Services. Know what is happening and why; what the possible alternatives, benefits, and risks are; and what you will need to pay. Ask your doctor about insurance coverage, but realize that some doctors deal with a dozen or more insurance plans, which often change their coverage. You might need to consult with the office staff for details.

Be savvy about medication expenses. With a heart condition, you may experience an increase in prescription costs to control high blood pressure or cholesterol. Talk with your health-care provider about your options. “Often doctors are not aware of the financial implications,” Shearer says. They might automatically write a prescription for a high-priced brand when safe, more affordable options are available. Ask about generic drugs. More insurance companies now have a tiered benefit, where sometimes there is no co-payment if you buy a generic instead of a brand-name drug.

Shop around for your prescription drugs. The cost varies greatly. Consider buying in bulk, online, or by mail order. In some cases you can safely split your pills, so you can buy a larger amount for the same co-pay.