Simple ways to understand your health insurance


Health insurance is confusing, but not understanding your coverage could leave you with unexpected medical bills. Although consumers have access to more information than ever, knowing the best sources for accurate advice can minimize misunderstanding and empower you to make the best decisions regarding your health care.

Deductibles, copayments and narrowed networks— it’s hard enough to decide when seeing a doctor is necessary, let alone to understand how health insurance figures into the equation.

If you can’t accurately forecast your share of a medical bill when presented with total cost, coinsurance amount and allowable charges from your insurance company, join the crowd. Only about 16 percent of people can, according to a 2014 Kaiser Family Foundation survey. Fortunately, good resources are available to help clear up the confusion.

Talk to your insurer

Health insurance plans vary widely. If you’re unsure which doctors are in your network, how high your deductible is or whether you need a referral to see a specialist, checking with your insurance company is the best bet.

Most insurance companies have user-friendly websites that allow you to plug in your policy details and get plan-specific information. But don’t be afraid to pick up the phone. Sometimes talking with someone directly is the best opportunity to clear confusion.

Talk to your employer

If your health insurance comes from your employer, your human resources representative may have some valuable plan-specific information.

A growing number of companies use outside firms to manage health plans and the questions that go along with them. You might be able to get assistance with negotiating your bill or access to a patient advocate for health insurance questions. HR can direct you to such resources, if available.

Ask your doctor

Although your doctor might not know the specifics of your plan, he has likely been working with insurance companies since he started practicing. As such, he might be able to give advice on how to shore up your medical records to prevent insurance denials or to help explain terms such as “medical necessity” and the referrals process.

Call billing offices

Whether you’re planning for medical costs in advance or you’ve received a bill you can’t decipher, billing offices can help explain charges and how insurance plays into your final amount due. Additionally, you can request an itemized bill from your medical provider if you only receive a summary. Seeing an itemized bill will help you identify possible errors or coverage issues when matched with the explanation of benefits you get from your insurer.

Get more information online

The web is packed with information on health insurance. But not all resources contain the most up-to-date and comprehensive information. Good bets include the Kaiser Family Foundation’s Understanding Health Insurance page,, and if you’ve purchased a plan through the Affordable Care Act marketplace or state exchanges.

For most people, health insurance is a good thing that can reduce overall health care costs. But if you don’t understand how it works or how to successfully navigate your policy, you could be left with a high bill and a whole lot of confusion.

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