Choose the Right Plan
When selecting a medical insurance plan, don’t automatically choose the one with the lowest monthly premium or the one you used before. Coverage and your doctor’s participation with a plan can change every year, as can your family’s health needs. If you are eligible to enroll in U-M medical insurance plans, carefully review the plan information during Open Enrollment each year and select the plan best suited to your needs.
Consider a Higher Deductible
To keep medical insurance premiums low, consider a high deductible plan. Your out-of-pocket costs will be higher, but a high-deductible (HD) health plan can save you hundreds of dollars per month in lower premiums. These plans, which have an annual deductible, can be a good choice if your family is healthy and doesn’t usually visit the doctor too often. An HD plan might not be right for you, though, if family members have chronic health conditions, saving money for emergencies would be a hardship, or if the thought of having to pay such a high deductible out-of-pocket makes you feel anxious.
The U-M Comprehensive Major Medical plan, administered by Blue Cross Blue Shield of Michigan, offers the lowest monthly premium for faculty and staff members (paid in full by the University for You Only coverage), but also provides the most limited benefits and has the highest out-of-pocket cost of all of the U-M medical plans. You must meet your annual deductible of $500 per individual or $1,000 per family before benefits are paid. Once you satisfy your deductible, the plan will pay 80 percent of most eligible services, while you pay the remaining 20 percent. View the Benefits Office website for more details on this and other medical plans.
If you enroll in a high deductible medical insurance plan, consider putting aside the money you are saving on monthly premiums into a Flexible Spending Account, which allows you to set aside pre-tax dollars for medical expenses.
Stay in Network
If you are enrolled in a managed care plan or HMO, such as UM Premier Care, HAP, Priority Health or a preferred provider plan, always try to choose doctors, hospitals and other providers that participate in your insurance company’s network. When making an appointment, always verify that the doctor is still in your plan’s network. Participating providers and hospitals are subject to change. And ask to see in-network providers when you go to the hospital or an urgent-care center. Just because a facility participates in your plan doesn’t mean every professional, such as the nurse-practitioner or radiologist, does.
If your plan requires you to get a referral to a specialist, take your insurance plan’s preferred-provider list to your primary-care appointment. Your doctor can easily select the best specialist who participates in your plan.
If you need to see a doctor when you are out of town, call your insurance provider’s toll-free customer service phone number to find out the best way to get services that will be covered. The phone number can usually be found on the back of your insurance ID card. Contact information and provider directories for U-M health care plans are available on the Benefits Office website.
Know Your Insurance Plan
Having good health insurance doesn’t mean you never have to worry about medical costs. Make sure you understand as much as you can about what types of medical services your policy covers. Even the best health insurance policies don’t provide unlimited coverage for every conceivable medical need. Health insurance providers may deny claims if your policy doesn't cover a particular procedure or type of care. Furthermore, most policies have substantial limitations and restrictions on benefits for a wide range of conditions, and many also require you to follow certain rules and procedures to make claims. Without carefully reviewing your policy, you may mistakenly assume that your insurance will pay the costs for the medical care you need even if the policy explicitly excludes coverage.
Before selecting a medical insurance plan, be sure to review your plan’s benefit guide or certificate of coverage to know what medical expenses are, and are not, covered. This is especially important if you or one of your covered dependents has a chronic condition or particular medical need.
Follow the Rules
Acquaint yourself with the procedures your insurance plan requires and follow them as much as you can. Some plans require that you get pre-approval on certain types of medical care before the care begins. If your doctor advises a particular course of treatment for a medical problem, contact your insurance company before proceeding with the treatment to make sure that you follow the required guidelines. Check the medical insurance coverage comparison chart available on the Benefits Office website or call your medical insurance provider. A customer service number is printed on the back of your medical insurance ID card. Medical insurance plan contact information is also available from the Benefits Office website.
Work with Your Doctor
While your doctor may be familiar with many medical plans, you are responsible for knowing what is or is not covered by your insurance plan. By arming yourself with knowledge about the coverage available in your particular plan, you may be able to work with your doctor to ensure that your insurance plan will cover your medical costs. If your doctor recommends a treatment or procedure that is not covered by your plan, ask how much the procedure will cost or ask if there is an alternative treatment that is covered by your plan.
Here are some other tips for working with your doctor and getting the most out of your appointment:
- Find a doctor you like and trust. Finding a doctor you are comfortable with can make a big difference in maintaining your health or controlling a chronic condition. Always let every doctor know which other doctors you see.
- Prepare for every visit. Know your symptoms and the medications and supplements you take, including vitamins, minerals or herbs. You might find the UM prescription drug plan pocket medication record helpful. (NOTE: This is a PDF file, which opens with Adobe Acrobat Reader.)
- Answer questions about your health history and habits honestly. Let your doctor know if you are using any nonstandard treatments or alternative therapies to treat your symptoms. Be truthful when answering questions about your lifestyle, such as your typical diet, how much you exercise each week, or how frequently you drink or smoke. This will help your doctor achieve a more accurate assessment of your general health, and provide guidance on how you might avoid risk and improve your health and wellbeing.
- Be open about your mental and emotional health. Emotional problems or stress may cause you to have trouble sleeping, alter your appetite or cause other symptoms. Your doctor can assess your condition and recommend a mental health professional to help you achieve balance in your life.
- Take an active role in every visit. Write down the questions you want answered, and make sure the doctor addresses them before the end of the visit. Take notes on diagnoses and treatments. Be honest and direct about what advice you can and can’t follow. Use the doctor’s knowledge to help you make decisions about your care. Ask your doctor about the benefits or side effects of any recommended treatment options.
- Follow the instructions for medical tests. For example, if you are told not to eat for 12 hours before a blood test, don’t eat. Otherwise you may not get accurate results or you may need to be retested. Keep a file of your test results and bring copies of tests run by other physicians to your appointment. If you have a disease that must be monitored, you can help decide how often the tests are performed. Don’t check into the hospital for tests unless you have to. Many tests can be done less expensively on an outpatient basis.
The Emergency Room is for Emergencies
Never use the emergency room as a substitute for your regular doctor. Copays at the emergency room are typically much higher than regular office visit copays, and the waiting time can be much longer. If you can’t wait for regular office hours, call your doctor’s office. An after-hours answering service will answer your call and can put you in touch with the on-call physician or triage nurse. But if you are suffering from a relatively minor condition that can wait until your doctor holds regular office hours, then do so. Of course if your symptoms are life threatening or require urgent care, don’t hesitate to go to the emergency room or call 911.
Urgent Care Facilities
If it is after your doctor’s normal office hours and your condition is not life-threatening, you may want to go to an urgent care facility. Call ahead to see if they accept your insurance and to ask how long you will have to wait before you will be seen by a health care provider.