People routinely face two challenges when it comes to healthcare, which are 1) where is the right place to go depending on my condition, and 2) what does my insurance cover?
The worst time to look for answers to these questions is evenings and weekends when some locations are closed or when you are feeling ill or facing an emergency. Because of this, taking the time to review your provider options and health insurance coverage in advance will serve you well.
Each year at the time of open enrollment, health insurance plans come with benefit guides that provide detailed information about deductibles, co-costs, out-of-pocket limits, in-network and out-of-network coverage, and other important information. You should also be advised if the plan contains a telehealth/telemedicine option; If your dental and vision plans are covered by your health insurance; What is included, excluded or added cost.
It’s a terrible feeling to think that a particular service is covered only to find out later that restrictions and limitations may apply; Hence, take the time to review your coverage and keep a summary of the benefits guide handy when scheduling routine appointments or in the event of an emergency.
Adult and pediatric primary care visits are the best source of care for routine wellness visits, chronic care, and non-life-threatening conditions. Primary care visits are also appropriate when a person feels ill and needs a diagnosis and course of treatment.
It can sometimes be difficult to see a primary care doctor on short notice; In such a situation, a visit to a rapid care facility (immediate primary care) or urgent care (emergency care in low acute situations) is a good alternative. Telehealth/Telemedicine can also provide convenient care at any time – weekdays, evenings, weekends, at home or away from home.
In order for these visits to be more successful, it is advisable to set up a telemedicine account in advance, so that you do not get stuck when you need to use the service. (Again, you’ll want to pre-check the availability of telehealth/telemedicine with your insurance plan.) The emergency department is great, you guessed it, for emergencies; But it’s not a great option for routine and preventive care, since being treated in an emergency facility results in high-cost care.
Understanding where you should go for care can affect how much you pay, how long you wait, and what treatment you receive. The cost is usually determined based on the type of facility you’re visiting – not just your injury or condition. A primary care provider or express care is usually the least expensive option, followed by urgent care. The emergency department is the most expensive option.
For people without health insurance, Memorial Regional Health has financial advisors to help with tiered scale and payment plans to ensure people continue to have affordable health care. In addition, MRH’s financial advisors and care coordination team can help connect people with resources to determine if they qualify for Medicaid or insurance on the open market. Call MRH’s Care Coordination Team at 970-826-8010 for more information.
Again, understanding your provider options and health care coverage can help you be proactive in taking care of your health, in both routine and emergency situations. Be prepared by keeping a summary of your benefits in a place easily accessible to all family members when scheduling health care appointments or in the event of an emergency.