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Top 5 Pitfalls of Employee Health Plans – Part III

One of the most challenging human capital business-insurance-employee-healthcare-plansdecisions employers are faced with is how to combat the rising costs of employee benefits. Employers need to weigh cost, network of physicians, and the employee out of pocket expenses against one another when vetting employee health plans.

More often than not HR Managers must consider changing insurance plans and possibly insurance companies. By the time your employees learn and understand their health plan, it’s time for that pesky renewal and all the changes that come along with it.

In the third part of this series, we explore the pitfalls associated with changing insurance companies and the surprise medical bills that could appear unexpectedly as a result.

Pitfall #3: 
Unexpected bills resulting from changing from one insurance company to another.

How To Avoid:

  • Plan Information: Changing insurance companies means your employees will receive new new ID cards. These cards will provide physicians and facilities with everything needed to process medical bills. It is important to ensure your employees update their doctors with this information. If they do not, the doctors will continue to submit services toward the out-dated plan resulting in denials.  You should ask your insurance company or broker to provide PDF copies of the temporary ID cards that can be distributed to your covered employees.
  • Laboratories: Insurance companies have partnerships with select laboratories. Only certain labs are considered participating in your plan’s network.  The general assumption is that your doctor knows which lab your new plan participates with and will therefore submit your bloodwork to the proper facility.  This couldn t be further from the case. Our health advocate team has had to untangle numerous denied claims for members who’s doctors sent their blood to incorrect labs. For example, Aetna primarily uses Quest Diagnostics whereas Oxford uses Labcorp. The best way to ensure your doctors process your blood work correctly is to provide this information at the start of your visit. Don’t just tell the doctor, but remind his staff as they are the ones who ultimately handle this back end process for the doctor.  
  • Prescriptions:  It is important to remember the cost of services vary by insurance company and pharmacy manager. A drug that may have been a Tier 2 – $20 co-pay on your old plan, may be a Tier 3 – $50 co-pay on your new plan. The best solution is to be proactive.  Research the cost of your prescriptions prior to purchase. In addition, some medications may require “prior-authorization” which is a fancy way of saying your doctor needs to call your new insurance company and file the prescription before you can purchase it. The insurance company provides detailed listings on their website which provides cost information as well as any restrictions there may be.

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

Topics: employee benefits, wellness, preventive care, health advocate, medical bills