Insurance

Healthcare in the lives of bleeders can be one of the most complex systems that we have to navigate.  An even more complex system to navigate is the insurance system. Some really important information that you should try to always know about your insurance is:

Know your carrier.  A carrier is the person that you have your insurance with.

Have an updated card.  Your card is the card that your receive from your insurance company that will have your member number, group number, and other important information.

Know if your plan is an HMO, PPO, POS, and/or has an HRA/HSA.  These different anacronyms stand for different kinds of health care plans and systems.

An HMO is a  health maintenance organization – A health care system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to HMO members, usually in return for a fixed, prepaid fee. Financial risk may be shared with the providers participating in the HMO.

A PPO is a preferred provider organization plan – An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or nondiscounted charges from the providers.

A POS is a Point-of-service plan – A POS plan is an “HMO/PPO” hybrid; sometimes referred to as an “open-ended” HMO when offered by an HMO. POS plans resemble HMOs for in-network services. Services received outside of the network are usually reimbursed in a manner similar to conventional indemnity plans (e.g., provider reimbursement based on a fee schedule or usual, customary and reasonable charges).

An HRA is a health reimbursement account. It is an employer-funded plan that reimburses employees for incurred medical expenses that are not covered by the company’s standard insurance plan. Because the employer funds the plan, any distributions are considered tax deductible (to the employer). Reimbursement dollars received by the employee are generally tax free.

An HSA is a health savings account that is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur.  Essentially, it is an account that money is put into that isn’t taxed and you can pay medical expenses from.

Know if you have both or either medical and pharmacy benefits.

Know if you have an out-of-network option. Your network is the medical professionals, hospitals, and other medical organizations that are covered under your insurance plan.  An out of network option means that you can get care from someone, or some hospital or other organization that is out of your network, but it can cost you more.

An excellent source for definitions of health insurance terms can be found at www.bls.gov

Visit our directory of Manufacturer Patient assistance programs. 

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