Three Health Insurance Mistakes to Avoid


Three Health Insurance Mistakes to Avoid

Don't pay more than you have to if you have a high-deductible plan and health savings account.

I just switched to a new health insurance plan through my employer, which took effect on January 1. It's the first time I've had a high-deductible plan and a health savings account. What do I need to know to make the most of this kind of health insurance?

Switching to a high-deductible health plan account can save you a lot of money in premiums, and you get tax breaks for using a health savings account. But you also need to become a much smarter health-care consumer to make sure the insurer gives you credit for everything you deserve. Here are three mistakes to avoid when you have a high-deductible health insurance policy.

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1. Not searching for the best health-care deals. People with low-deductible policies usually don't spend much time thinking about their health-care costs -- especially if the insurer picks up most of the tab. But when you have to pay for the first thousand dollars or so of medical expenses, it becomes much more important to find good deals.

The following steps can make a big difference in your out-of-pocket bills: Go to a convenience-care clinic instead of an urgent-care center or an emergency room, when possible. Emergency-room visits tend to cost $300 to $1,000, compared with $150 at an urgent-care center and $35 to $45 at a convenience-care clinic. And make sure the facility and the provider are in your health plan's network so that your payment counts toward your deductible. For non-emergencies, it pays to call your insurer's 24-hour advice hotline for guidance on where to go for care. Having your call on record can help if you need to appeal a denied claim.


You can also save a lot of money by switching to generic medications or other low-cost equivalents. Most insurers' Web sites show the cost of various options. Or visit DestinationRx's Web site, and use the Medicine Cabinet feature to compare prices for similar drugs, as well as the cost at pharmacies in your area compared with mail-order pharmacies, which tend to be cheaper.

Most insurers also have Web tools to compare prices for hospitals and providers based on quality and cost. Also check out the cost for freestanding imaging centers, which tend to charge a lot less than hospitals for tests, such as MRIs and CAT scans.

2. Not getting charged the right rate. People with high-deductible policies who pay the full amount for many health-care services out-of-pocket (until they satisfy their deductible) are often mistakenly charged the more-expensive, uninsured rate rather than the rate that the insurer negotiates with health-care providers, says Tom Bridenstine, the managed-care ombudsman with the Virginia Bureau of Insurance. When possible, talk with the provider's billing office beforehand to make sure you're being charged the appropriate rate, even though you'll be paying the bill yourself.

3. Not getting full credit toward your deductible. Verify that all of your eligible out-of-pocket payments are credited toward your deductible. And find out the details about the deductible rules before you choose your provider. Some plans have one deductible for in-network providers and another for out-of-network providers, says Bridenstine. And if the out-of-network provider “balance bills” you -- which means that it charges you above the amount the insurer will pay -- ask whether that counts toward your deductible? (It usually does not.) Also find out if any benefits have first-dollar coverage. Some plans, for example, cover routine care and pharmacy benefits even though you haven't reached your deductible.

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