Getting the Most from your Health Coverage

How can you utilize your healthcare benefits most effectively? Be an active participant in your own health and health care by:

  • Remembering the importance of preventive care
    Find out about health screenings and see that you get them.
  • Eating well
    There's a shred of truth in the old adage, "an apple a day keeps the doctor away." A healthy, balanced diet can help you avoid a multitude of health problems (like obesity, heart disease and adult-onset diabetes), and helps with many pre-existing conditions (like high blood pressure and depression).
  • Exercising NOW, not later
    Studies show that even moderate exercise three times per week can offset an adult's risk for heart attack, stroke and certain cancers.
  • Always asking your doctor questions, and listening for clear answers
    Know what prescriptions you are taking, when to take them and what not to mix with them. Ask about the risks and benefits of each test and treatment. Make certain that you understand your doctor's responses. Go ahead and take notes, if necessary.
  • When in doubt, writing it down
    While we're on the subject of taking notes, remember to keep a log or diary of symptoms, concerns or unusual problems that occur. That way, you have a clear record when it comes time to meet with the doctor. Also, make sure to keep a record of treatments, vaccinations, lab tests, drug reactions and side effects.
  • Knowing your policy
    Read your coverage policy and member handbook -- particularly the information on benefits, coverage, exclusions and limits. If your plan has a newsletter or magazine, make sure to read it as well. You can keep abreast of policy changes and new services that may affect your care.
  • Knowing how to obtain care
    Don't wait until it's 4 a.m. and you are having a bizarre reaction to the shellfish you had for dinner -- learn coverage specifics like urgent-care hours and how to schedule appointments now, while you feel good. Don't forget to find out how (and where) to get lab tests, as well as what number to call in an emergency.
  • When you're sick about the treatment you received
    If you have a bad experience with your managed health care provider, you have the right to complain. Contact the member services division of your plan immediately for more information on how to register a complaint. Health insurance plans have grievance or appeal processes. While in the complaint process, be sure to save records of all correspondence, claim forms and copies of bills. Also keep a log of phone conversations and names of the people you speak with.

If this process doesn't solve your problem, you might consider bringing the matter to the state insurance commissioner or state department of health. Medicare or Medicaid recipients may file a grievance with the state's Medicaid program as well as the state medical peer review organization.

Reprinted with permission from Kelsey National Corporation.