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Published on October 29, 2019

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Know Your Health Benefits for Great ROI

You might be surprised, but you – as well as your health insurance provider – are both looking at the facts and trying to find the best ways for you to stay as healthy as possible.

One of the best ways to do that is to take advantage of all the benefits that come with your health insurance plan. Taking some study time to know what you’re already paying for is time well spent.

“We encourage all of our members to take the time to get to know their plan, its benefits and the ways preventive services can help them achieve their best possible health,” said Katie Studer, Director of Customer Experience with Avera Health Plans. “Working with our members, we can help them approach their coverage in a proactive fashion and put to use the screenings and other services that can help them, and their care providers, identify any issues.”

Addressing potential health issues in a timely fashion is part of an approach called population health management, Studer said. It’s an approach that highlights prevention, quality and the importance of seamless integration between different areas within the health care system.

“We cover all the facets with robust support, and that includes our member advocates, health coaches and our customer care team,” she said. “Population health is an extension of Avera’s mission – of our culture and our focus on patient-centered care in our facilities. In our insurance division, we have the same mindset, where the member is the priority. We all are working to serve them.”

Integrated health systems like Avera allow those preventive benefits to pay off due to the fact every aspect of care can be brought together. Exams and screenings can catch an illness or condition at its onset; the care provider can then refer a member to a specialist if concerns are identified.

“Insurance can be a confusing product in general, for almost anyone,” Studer said. “Reviewing your plan and understanding it fully can save you money.”

Here are some additional tips Studer recommends:

  • Understand which care providers are in your network. Before you schedule an appointment, make sure your insurance will cover it, since out-of-network care can lead to higher out-of-pocket costs.
  • Know when to use urgent or emergency care. “On average, an emergency room visit can cost $2,000 while an average urgent care visit is only $155,” she said.
  • Read your summary of benefits and coverage (SBC) so that you know what your monthly payment is going toward. Your SBC outlines everything in your plan. Call your customer care team with questions.
  • Make use of preventive services. Many health insurance plans are required to cover certain services, such as recommended mammograms, colon cancer screening tests, cholesterol and blood-sugar checks, immunizations and more.
  • See if your plan allows for online access, so you can use it to see your explanation of benefits, search for in-network providers and facilities or read your SBC. Many plans offer customer or patient portals that give you plenty of online resources.
  • Verify what kind of emergency transport is covered since not all trips to the doctor are planned. Emergency air transport memberships, when available can save you thousands of dollars.
  • Review your plan’s information on prescriptions. Since you’ll likely face a higher co-pay for brand medications, talk to your provider about generic options. You can also review this information with the customer care team or online.

Finally, make sure everyone is covered. You might have dependents who live outside your network coverage area, for example, college students. Your customer care team can answer questions about extended-network coverage for dependents.

Knowing more will save money, and also ensure those dependents receive the care they need.

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Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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