What to Expect During Your First Trip to the Doctor with Your New Insurance Plan

Whether you’re visiting your doctor for a regular checkup or an emergency, the first time you visit with new insurance may be tricky. Here’s what to expect during your first trip to the doctor with your new insurance pl

1. Make sure to give the doctor your new insurance card.

It may seem obvious that you’ll need to show your doctor’s office your new card, but you might be so in the habit of showing your old card, that you could forget. (Remember, whatever I.D. card that the doctor has on file is what will be billed to your insurance provider.)

You will want to ensure that your provider has the most current benefits information available when they verify and bill your insurance provider.

If you’re officially enrolled in your new plan, but your insurance card hasn’t arrived in the mail yet, it might be possible to print off a temporary card and use that. If not, you may need to pay the full amount out of pocket and get reimbursed once you have your card in hand. Most all insurance companies now provide a member portal for you to enroll in where you can print a temporary I.D. card. (Contact your broker for more information about your medical insurance companies process.)

2. Payment depends on the nature of care you receive.

If you are at the doctor for preventative care - whether for an annual physical or other covered preventive service - your insurance should fully cover your visit. In other words, you would pay nothing when you leave. However, if as a result of your preventative care, your doctor discovers you need treatment (if you tested positive for diabetes, for example), you’d have to pay for that.

If you are at the doctor for anything else, such as for the flu or a sprained ankle, you’ll need to pay for your share of the visit (including any deductibles, copayments and coinsurance). This expense, remember, will go towards your out of pocket maximum.

3. Don’t mistake your Explanation of Benefits form as a new bill.

Your Explanation of Benefits form might look like a bill, but this is really the explanation of how the insurance company has processed your claim. (You can also access your EOB’s through your online member portal.)

4. Consider prescription alternatives.

When acquiring a prescription from your provider be sure to ask if there are generic versions available, as this will help you save money once you go to the pharmacy .

5. Look into prior authorization.

Some services do require that your provider submit a request for prior authorization (M.R.I.’s, for example, almost always do).

Be sure to check with your policy to see if a service you are having requires this. The prior authorization process can take anywhere from 3 days to a week for the insurance carrier’s review.

--

And that’s it! We know that first time or two you use a new insurance plan to get health care can be a little stressful. Hopefully these tips helped take some of the confusion and frustration out of the process.