Top 5 Pitfalls of Employee Health Plans – Part I

We all live in a world of bills, bills, and more bills! It’s hard enough for your employees to keep up with the mortgage or rent, utilities and credit card payments but the leading cause of all bankrupcies in the US is medical debt!


One of the keys to administering successful employee health plans is helping employees understand the basic questions they should be asking when using their insurance.

When you buy a car, do you drive the car off the lot without looking at the sticker price?  So why is it with health insurance that we go to the doctor or schedule a service without asking some basic questions?

In this five part series you will learn the key ways to help you and your employees get the most from their employee benefits and avoid surprise bills that could lead to serious financial hardship.  Medical bills and confusing insurance jargon can throw even the most experienced HR manger for a loop.  For most people, speaking to the insurance company is like trying to understand a foreign language.

Pitfall #1: 

Getting crushed with an out of network bill because you used an out of network doctor:

How To Avoid:

It’s not as easy as asking your doctor “Do you take my insurance?”  Each insurance company has lots of different “networks.”  Odds are your doctor only participates with a select few.  You can help your employees determine if their doctor accepts your group plan’s network in several ways:

  • The quickest way to check if a doctor participates in your network is by visiting your insurance company’s website. The only issue is that most insurance websites  have tons of networks to choose from (Aetna has over 70!).  By registering and logging into your account online, you can search for your doctor without having to actually select the plan you have. Most insurance companies will link the Doctor Search to your plan directly provided you register an online account.
  • Another option is to provide a health advocate service for your staff.  Here at Ashton Benefits we provide each member and their family members with a personal health advocate.  Our dedicated specialists are here to assist employees with finding doctors, billing questions and claims issues. Unlike the insurance companies, when a member contacts an advocate, they will not be required to enter a million prompts before speaking to a live representative.
  • Believe it or not, often times calling the doctor’s office might not even give you correct information as to what insurance your doctor accepts . You would think that asking your doctor’s office “Do you take my plan?” is sufficient enough but unfortunately this is far from the case.  Most doctors will say “yes” and later submit toward an out of network benefit that results in a much higher cost.  When speaking with a doctor’s office, the key term is “In-Network.”  For example, “Do you accept the Oxford – Liberty HMO as In Network doctor?” This will clear up any confusion.
  • By far, the most common “network” blunder encountered by employees when seeking care in a hospital or facility.  SO many people are involved with your care!  It is important to ensure with the facility that all parties are “in-network”.  This includes the hospital, surgeon, and anesthesiologist for example.  Just because a doctor is part of the plan, does not necessarily mean the hospitals they are affiliated with are in-network as well.

What’s next?

Did you know that when you see in network doctors, lots of preventive care services are covered by your insurance plan at no charge? Download our free guide to learn what preventive care services you and your employees are eligible for under your group health insurance plan.

Download Free Guide