How to Use Health Insurance

How to Use Health Insurance

If you have a new health insurance plan, you probably have questions about how to start using it. Two things you need to know to get started are how to find a doctor and where to get your medicine. 

How to Find a Doctor - the Right One

Now that you have new health insurance, it is time to choose a doctor to help you get the most of your benefits. Choosing the one who is right for you is just that— a choice. Here are some tips on how to find a doctor or other health care provider to meet your needs:

  • Talk to family members, friends, or co-workers and ask if they have any recommendations. Ask them what they like or don’t like about each doctor. There are some websites dedicated to doctor reviews and ratings.
  • Find the names of medical professionals near you who are in your health plan's network so you will have lower out-of-pocket costs.
  • Talk to family members, friends, or co-workers and ask if they have any recommendations. Ask them what they like or don’t like about each doctor. There are some websites dedicated to doctor reviews and ratings.
  • Narrow down your choices. When you have found a few doctors you might want to try, call their offices. Ask the office staff these questions to help you decide:
  • When is the office open? Are evening or weekend appointments offered?
  • Are they accepting new patients?
  • Which hospital(s) does the doctor use to see patients?
  • How long does it take to get an appointment?
  • Is the office close to your home or your work? Will it be easy for you to get there?
  • Does the doctor or someone in the office speak your language?

Give the doctor a try. The next step is to schedule a visit with your top choice. During your first visit, think about how easy it is to talk with the doctor and if the doctor is a good fit for you. Remember, if you are not comfortable with your doctor, it is okay to look for another one.

Where to Get Medications

If your new health insurance plan includes a pharmacy benefit, the plan will help pay the cost of certain drugs. You will be able to get your medicine from many choices of drug stores. Just like providers, certain drug stores will contract with your health plan to offer reduced costs for your prescriptions. Make sure you use a drug store that’s in your health plan’s pharmacy network to keep your drug costs low. You can also find out if you are able to get your medicine delivered to you in the mail. Mail order prescriptions may cost you less.

You also can keep drug costs low by using medicine that is covered by your plan. You’ll want to use your plan’s formulary, or drug list, to find out what's covered.

To find out if a drug you take is covered, you will need to know:

  • The medicine's exact name
  • The quantity of medication your doctor often prescribes
  • The dose you are prescribed

If your drug coverage is part of your BCBS health plan, you can look at your plan’s drug list by logging into Blue Access for MembersSM and clicking the “Prescription Drugs” Quick Link.

If a drug you take isn’t covered under your formulary, you can take these steps:

  • Talk to your doctor about options. A generic version or another covered drug could be a better choice for you.
  • Your doctor can ask that your insurer cover a drug not on its formulary if there is a health need.
  • If the request is denied, you have the right to appeal your health plan's decision and provide information to support your need for the drug.

Does this help?

Originally published October 1, 2014

Anonymous