Posts for tag: Out-of-Network
Open Enrollment Time Will Be Here Again for Family Health Insurance Coverage
The Healthcare.gov Open Enrollment period is November 15, 2014 to February 15, 2015. Coverage can start as soon as January 1, 2015. Private Insurance may have a different Open Enrollment time-frame. Please double check.
Signing up November 15, 2014 to December 15, 2014; coverage starts January 1, 2015.
Signing up December 16, 2014 to January 15, 2015; coverage starts February 1, 2015.
Signing up January 16, 2015 to February 15, 2015; coverage starts March 1, 2015.
Can You Answer These Questions?
Do you want to have freedom of choice to pick your child’s pediatrician without undue pressure from the insurance industry?
Do you want your child’s pediatrician to make recommendations regarding your child’s health without pressures or incentives from the insurance industry?
Do you want to have real-time access to your child’s pediatrician without having to go through multiple layers of personnel and telephone trees?
Do you want direct access to your doctor by phone, text, email and other IT modalities, e.g. Skype?
Priority Pediatrics PC, the practice of Dr. Marc Tanenbaum, offers personalized primary pediatric care in your home. As a small out-of-network practice, Dr. T is able to offer infants, children, adolescents and their parents his time and expertise without constraints dictated by the insurance industry. This means more time spent with you and your family and the availability to have medical care that works around your schedule__all at a very affordable price. Dr. T has over 36 years of experience in pediatric medicine and you can be sure your children will receive superior medical care.
Priority Pediatrics, PC blends the best of 21st century medicine with the care, time and convenience of 50 years ago, when doctors made house calls.
Open enrollment is the one time each year, families can change their health policies and health savings accounts.
Not all policies are the same. Open Enrollment time-frames may differ between Insurance Carriers. Don’t miss this important annual opportunity to choose a policy that will reimburse you for an out-of-network provider like Priority Pediatrics PC, whose services to your children are provided in your home.
Summary of Benefits and Coverage (SBC)
An SBC is an easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You'll get the "Summary of Benefits and Coverage" (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company.
Health Insurance Solutions for Individuals
Many individuals find their annual health insurance costs increasing exponentially. Others find that even with a “catastrophic” insurance plan, basic medical care (the type of care that is used most often) is not covered, resulting in more out-of-pocket expenses.
Priority Pediatrics PC’s solution to this is for patients to combine a high-deductible insurance coverage plan with an HRA (Health Reimbursement Arrangement) that will allow you to reduce the monthly expense of your insurance plan while getting excellent direct, primary preventative pediatric wellness care and sick care from Priority Pediatrics PC delivered in your home.
High Deductible Insurance Plans
A deductible, in insurance terms, is the amount you must pay for health care before payments from the insurance company begin. After the deductible is met, insurance companies typically pay 50 to 80 percent of covered expenses up to certain annual limits, depending on the plan. In general, the higher the deductible, the lower the monthly premium. You will save a substantial amount in premiums, in exchange for paying more in out-of-pocket costs before insurance coverage begins, including expenses for routine primary and preventive care. To be a member patient in Priority Pediatrics PC entails an out-of-pocket cost approximating the cost of one cafe-latte per day for your first child, and even less for subsequent children. A further discount is offered for older children
Health Savings Account
One way to ensure that you are able to meet the increased out-of-pocket expenses associated with a high deductible health insurance plan is to set money aside each month in a readily accessible tax-free savings account. Thanks to recent federal legislation, a Health Savings Account is a current option that is growing in popularity for this purpose. Certain “qualified” high deductible insurance plans allow you to open a health savings account and make tax-exempt contributions that can be used for medical expenses not covered by your insurance.
Flexible Spending Account
A Flexible Spending Account (FSA) allows you to contribute money from your paycheck to a special fund that can be used for eligible healthcare expenses. Your contributions are made pre-tax, which saves you money, and can be used for medical expenses and dependent care, including child-care costs. Some employees have been wary of FSAs since unused funds generally expire.
Questions to ask Potential Insurers As You Shop & Compare
What is the best way to find out in advance what I will have to pay for out-of-network care? Is the policy for reimbursing out-of-network care posted on your insurer’s website or otherwise available?
What are the rules for accessing care outside my plan’s network? For example, how will I know if a service or test needs to be pre-authorized? Is there a phone number that I need to call?
What services and tests are covered by my plan (well check ups, sick care, home visits, immunizations)? Will they be covered if performed by an out-of-network provider (an out-of-network pediatrician)? What services or tests are excluded?
What happens if my out-of-network doctor sends my child to an in-network laboratory? Would I be responsible for additional costs? If so, how can I guard against this additional expense?
Is there a deductible? Do both in-network and out-of-network services count towards the same deductible? Do pharmacy services and laboratory services count towards the same deductible?
How does the plan cover emergency & urgent care services when referred by a non-network provider? How does the plan define “emergency” services? If I (or my child) am brought by ambulance to a non-participating Emergency Room, am I financially responsible for a decision that was not in my control?
Always make a note of the date and the name of the person(s) you spoke with.
Priority Pediatrics for Your Children's Primary Care
The combination of Priority Pediatrics PC plus a high deductible insurance plan, leverages the best characteristics of both types of health care coverage: better access, exceptional service and affordable pricing that are the hallmark of direct primary care plus the affordable coverage provided by your high-deductible insurance. We support your "obtaining out of network" benefits through our invoice statement summary sent to you and your claim submission to your insurer for reimbursement for needed health care. We will itemize our invoiced services to you as best we can for your insurance claim, but we must leave it to you to confirm your out-of-network benefits with your chosen insurer.
Priority Pediatrics PC accepts new patients throughout the year, however, we do limit membership to maintain our high standards of excellence and service.
Clearly, health insurance options for families and their children are complex and in flux. The following articles have been chosen to offer you consumer advice on using your Open Enrollment period to make good choices about your doctors and health insurance coverage. Consulting with your financial and legal advisors as you shop for health insurance may be in your best interest.