4 Tips for OPEN ENROLLMENT

Well it’s here, open enrollment.  If you haven’t acted yet, you have until the end of the year to get yourself on coverage for 2017 and who knows where things will go from there?

If you’ve made the mistake of treating health care insurance coverage like your health care provider, you’ve likely experienced the burn of poor care or outrageous out of network costs for the quality medical care you deserve.  Use these 4 tips to evaluate your health insurance before it’s too late (yes this was written by an eye care provider — also a medical professional):

1.  Don’t mistake HMO premiums as a benefit if you might ever need a specialist.  Yes, HMO specialists are available but they may not be the doctors you’d choose for you and your family, just the ones that the closed network allow on the panel.  A prime example might be eye care for dry eye.  I see a number of patients with medical dry eye and evaluate and manage their condition through their medical insurance.  BUT I’ve also had to charge patients with HMO’s directly because the insurance companies and hospitals will not allow a medical professional like myself to participate in the care of its patients.  A number of dry eye patients are seen by ophthalmic surgeons daily, and unfortunately if the surgeon has not taken the time to educate themselves on the latest diagnostics and treatments of dry eye the patient suffers because there isn’t a surgical treatment for the condition.  At 4Sight iCare we are on all major medical PPO plans (http://4sighticare.com/patients/insurance-information/) and no patient is asked to pay more than what their insurance dictates as the cost for a proper medical office visit and medically necessary testing.
2. Find a plan that works for the whole family and shop around rather than settling.  You can use a broker we recommend a local insurance agent: http://deruzzoassociates.com/) to shop at no additional costs to you.  Compare those individual and group plans to the ones offered by your employer.  Often times the contributions of an employer improve the potential benefits, but occasionally the individual plan you can craft with a broker will be better tailored for you than the one your employer specified on your behalf.  The landscape of healthcare will change again over the next 4 years, and no one knows what to expect, including your employer.  And if you have control over the benefits that you know you are most likely to take advantage of then you know you are covered at a rate that is reasonable for the coverage you need. Taking what you are given just because someone in the HR department says so isn’t always the best choice.  Take a moment to investigate and invest wisely in your one greatest asset: your health.  Even if you find that the best option is to stay with what you have been offered, you will know your benefits well enough to use them when you need them.  The right time to research your benefits is never when you need them to go into action.
3. Don’t mistake pre-paid benefits for insurance plans.  Vision and dental plans are notorious for this.  People falsely believe that these plans will pay for any services they want when they need them.  Just walk in and ask for a wellness exam tomorrow at your optometrist or dentist.  They will be initially be grateful you called but then shortly after they will inform you that your cleaning was just done or your annual eye exam eligibility is valid after the first of the year — that is if you have used your benefits for 2016.  See, if you use your medical insurance for a medical problem and that problem recurs you can go in again, and again, and again until it goes away or enters into a part of your chronic care.  If your vision changes you can’t just come in again, and again and again under your vision insurance.  These prepaid benefits have premiums and the doctor accepts less than his/her usual fee in order to get more patients to take advantage of the service, but the wellness plans are just like your medical wellness visit — once it is used it is gone for the year.  That’s why they refer to it as an annual wellness physical: you get checked, pay a $0 copay with your medical insurance and go on enjoying life.  Vision and dental benefits enable you much the same but be conscious of the little known alternatives to be discussed in #4.  And when you’re searching for a new doctor, go to the most expensive location you can to get the best exam you can.  After-all, if you’re using a vision plan, the copay will be the same no matter which provider you see!
4. Do a comprehensive exam every year, but use intermediate to advanced level office visits for everything else.  The coding experts have numbers for each service and a dollar amount attached to the code.  If you’ve had your annual wellness eye exam but didn’t buy glasses know that you can still visit your doctor at a much discounted rate for an intermediate vision visit.  So long as the annual exam has been completed – the doctor can check vision and refract for glasses under just those service fees and save you time and money in the process by using an intermediate level visit.  At 4Sight iCare our established patients may pay just $25 for a 92012 where the vision is tested without testing depth-perception, color vision, intra-ocular pressure, general eye health, or any other aspect that was already completed within the year at a comprehensive wellness eye exam.  This vision visit can also be applied for new patients who had a satisfactory exam somewhere else but just want the absolute best glasses prescription before spending the money on a new pair of glasses for just $10 more.  We ask for proof of stable, healthy vision and eyes checked by a doctor of optometry by providing an existing prescription before we see a new patient with an intermediate visit.  These intermediate exams aren’t comprehensive and are not typically covered by your vision plan, but if you are 3 to 12 months away from your next eligibility period it can be well worth it to check for vision changes before utilizing your benefit to purchase glasses.  If you get an eye infection or a sudden eye pain or a anything eye related, go to an eye doctor just as you would think of your dentist’s office if you experienced a toothache, gum infection, or sudden loss of a tooth.  In eye care these visits are medical and if you see an eye doctor that is on medical panels for eye healthcare you’ll see the benefit kick in on a medical office visit determined by criteria used to rank the visit.

I mentioned the billing and coders above and medical coding is complex but one of the inspirations of our name is the 4 common levels of eye care visits: 1 being the most elementary of office visits and 4 the most comprehensive.  At 4Sight iCare we believe in providing the best level of care possible, but we also do it at the most reasonable and equitable cost to our patients.  That’s what we mean by medical eye care.

CALL to use your 2016 benefits before it’s too late: 815-676-4474.

-Dr. Mark W. Burke