Things YOU should know about YOUR insurance..

[0oAmericanGirl]

I can't tell you how many time I deal with idiots who don't know a thing about thier insurance and expect me to explain it to them...(inspired by the pharmacy tips board)

1. Know what kind of insurance you have and if your local hospital is a particapating provider. HMOs, PPOs, POSs, ect.. may not be accepted everywhere or you might have to pay out of network benifits (you normally have a 90% coverage, but you'll have only 75%). Avoid places that don't take your type of insurance unless it's a true emergency, then your insurance should coover at the normal rate IF they're deacent.

2. Know your deductible. Your deductable is the amount you will have to pay before your insurance will cover at it's regular percentage. It's not my job to know your deductible, it's your insurance and you pay for it so read the little contract you signed.

3. Know your maximum out of pocket cost. This is the amount that you will have to pay before they cover at 100%. This is very important and you need to keep track what you have paid out so if your insurance company or the person filing your bill makes a mistake.

4. I don't expect you to know what tests require percerts for your insurance, however I do expect that if you know that you're having an MRI one month from today, that you'll at least call and find out your benifits BEFORE your appointment so you're not arguing with me.

5. Know what kinds of diagnostic testing and preventative care your insurace does and does not cover. Most insurances won't cover adult immunization and it's important that you know it.

6. Know if your insurance has maternity benifits before getting pregnant, if it's accidental you better call and find out before you make a doctors appointment so you can make arrangements or apply for assistance.

7. Know where your flippin' card is! I sure the hell am not going to call blue cross to find out YOUR number. If you've lost your card, get the damn number before you come in!!!

[AFpheonix]

1)Amen on the bringing insurance card! It doesn't help me if you tell me that it's Blue Cross. I can think of at least 20 blue cross plans off the top of my head, very few of which have the same carrier.

2)Know that not all pharmacies accept your insurance. You work for Costco, your insurance only covers scripts filled at Costco, or Rite Aid after hours. Not us. Sorry, dude.

3)Be aware that Worker's Comp and Auto RX will occasionally make you jump through hoops to get your meds. That how it works, if you want this stuff for free. Deal.

4)Be aware that there is a formulary. I don't expect you to know where all your meds fall on it, but just to be aware that some stuff just doesn't get covered well if at all. Behold, the power of tiers.

[PuckishOne]

The Thing You REALLY Should Know About Your Insurance:

Whether or not you have it.

We get calls from provider's offices trying to verify coverage on people whose coverage has either lapsed, doesn't exist yet, or never existed in the first place. One guy was apparently carrying around his insurance card from over 5 years ago; another one was genuinely surprised to hear that his coverage hadn't magically started on the appointed date despite the fact that he'd never sent in his enrollment paperwork.

[AFpheonix]

Ah yes, another one. Be aware that for the first half of January, every insurance company just got done playing Musical Coverage, so their systems will be crashing, you probably have a new carrier, ID, or group, and if you're lucky, I may be familiar enough with your plan to know what it went to.

If I'm not, well, sorry, sucks to be you.

Your formulary and stuff may have changed, too. I'm sure you were sent a letter. No, I don't know why your copay is different, unless of course you're on a plan that typically has a deductible, in which case I will spend the next 6 months reminding you that it just rolled over. Yay.

[PharmTechPhantom]

At the pharmacy, when people yell at me because their insurance is jerking them around, I just want to say "Why don't YOU know anything about YOUR insurance policy?"

[AFpheonix]

And another one from yesterday:
Hey, old people on Tricare! If you don't have Medicare Part D, then you either need to sign up or tell Tricare, because they are going to be bouncing your claims back.

No, MPD is NOT the same as Medicare A or B. Trust me.

[Brighid45]

As someone on the other side of the counter, I agree with everything that's been said here . . . and as you all well know, most customers are either not capable of figuring things out for themselves, or they will refuse to because 'it's someone else's job'--namely yours, since you're standing behind the counter and are an easy target.

[PharmTechPhantom]

My point is this: I do not work for your insurance company. I work for (faceless pharmacy chain).

Oh yeah, and Medicare Part D is a disaster. I feel like a giant a-hole when I have to tell elderly folks that the same medicine that cost them 28 bucks last month is now 300 dollars. I hope Bush isn't patting himself on the back too hard.