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Does working with CBC cost me anything?
All the services offered by CBC are provided at no extra cost to you. If you purchase a health insurance plan with the assistance of CBC, you'll pay the regular monthly premium to the health insurance company you chose, but you'll pay nothing to us. Our fees are paid by the insurance companies in the form of commissions, which are built into the premium amount.
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How can I reduce the cost of prescription drugs?
Prescription costs can eat up a large portion of your budget if you take prescription drugs regularly. Fortunately, it's not hard to find ways to save money. For example, try ordering your prescriptions through the mail, using a traditional or online pharmacy. If your health insurance plan includes prescription drug coverage, you may be able to receive a three-month supply of your prescription drug through the mail at a reduced cost. You can also ask your pharmacist or doctor to recommend a less expensive generic drug whenever possible. If you are not sure what generic drugs can be used to treat your condition, you can take a copy of your carrier's formulary list to your doctor for his/her recommendation.
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How can protect myself from being over charged when accessing care?
Medical bills are often confusing to read. However, taking a few minutes to go over the charges may save you money in the long run. Check to make sure that the bill accurately reflects the procedures you have undergone and takes into account any applicable insurance coverage you may have. Some errors, such as the wrong procedure code, are common, and you may be billed for healthcare you never received. Contact the appropriate billing office if you think you've found a mistake. If you've received an explanation of benefits from your insurance company that you believe is wrong, ask the company to review your claim. If you are not sure of any charges on a bill or EOB are correct, make sure you contact the CBCVIP Service Team for assistance.
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Should I join my spouse's health plan?
Many married couples maintain separate health insurance coverage even though it may not be cost effective to do so. Examine both your coverage and your spouse's coverage to see if it makes sense for either of you to join the other's plan. However, you may pay more in premium than you will receive in benefits. Keep in mind that most plans allow you to add a spouse to your plan within a certain time period after you get married (e.g. 30 days). Otherwise, you may have to wait for the plan's annual open enrollment period.
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Why should I keep track of my medical expenses?
Come tax time, you may be able to deduct certain medical expenses if you itemize and your total medical expenses exceed 7.5 percent of your adjusted gross income. Allowable medical expenses include everything from healthcare services to medical aids (e.g. eyeglasses, hearing aids). Keep track of these expenses if there's a chance you'll be able to deduct them on your income tax return. Consult with your tax advisor for more information.
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Can I negotiate a fee for service with my Provider?
Many people don't realize that you can sometimes negotiate to lower your medical bills. While it may not always work, it doesn't hurt to ask your doctor, hospital, or pharmacy if they're willing to come down in price. Before you begin to negotiate, do a little research to find out what other healthcare providers in your area are charging. You can also ask your healthcare provider if they'll lower their price if you pay in cash up front.
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What types of health insurance are available? (3 part answer)
• Health insurance plans generally fall into one of two categories: indemnity plans (also known as reimbursement plans) and managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans.
• An indemnity plan allows you to choose your own doctors and pays for your medical expenses--totally, in part, or up to a specified amount per day for a specified number of days.
• Managed care plans generally provide broader coverage, but they all involve an arrangement between the insurer and a selected network of healthcare providers (doctors, hospitals, etc.). For example, an HMO will require that a primary care physician in the network coordinate all of your care and refer you to specialists in the network.
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What services might be covered?
When comparing health insurance plans, check to see if they provide additional benefits that you may need, including:
• Prescription drugs
• Preventive care
• Mental health benefits
• Maternity care
• Vision care
• Dental care
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How much does accessing care cost?
In addition to the monthly premium expense, you may have other out-of-pocket expenses. These costs can really add up, especially if you have children or other family members who visit the doctor frequently. Check to see if the health insurance plan you're considering requires you to pay any or all of the following:
• Copayment: The amount you'll have to pay each time you visit a health insurance provider.
• Deductible: The amount you'll have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims.
• Coinsurance: The percentage of your medical costs you'll have to pay after you reach any deductibles that apply.
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How do I decide which plan is best for my family and me?
The best health insurance plan for you is the one that gives you the greatest flexibility and the most benefits for the lowest cost. Unfortunately, there´s no such thing as a standard health insurance plan. As you would when making any major purchase, you´ll need to shop around and get several quotes before choosing a plan. Here are a few points to consider:
• What copays, deductibles, and coinsurance requirements apply?
• How much freedom do you have to choose your own healthcare providers?
• Does the plan cover the health services that you need?
• Does the plan cover the healthcare providers you´re currently using?
• Does the plan offer family, as well as individual, coverage?
• Does the plan cover pre-existing conditions? If so, is there a waiting period before those conditions would be covered?
• Does the insurance company have a good reputation in the industry and a positive rating from a major ratings organization? (Contact your state´s department of insurance for more information.)
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What is a Health Maintenance Organization (HMO)?
A health insurance plan that entitles individual members to an array of medical services provided by participating physicians, hospitals, and clinics. Under an HMO, you must choose a Primary Care Physician and they must provide you with a referral before you can access care from a specialist.
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What is a Preferred Provider Organization (PPO)?
A healthcare organization composed of physicians, hospitals, or other providers which provides healthcare services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is often a deductible for out-of-network expenses and a higher copayment. A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO. After any visit, the policy holder must submit a claim, and will be reimbursed for the visit minus his/her copayment.
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What is a deductible?
This is the amount you are required to pay before your benefits begin on specific services. It is similar to the excess you pay when you have a claim under a motor policy but of course is much lower. Health insurance plans may include a deductible on expenses for prescriptions and on major medical expenses.
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What do you mean by coinsurance?
You will normally see coinsurance under major medical plans, where the plan pays 80% of your covered medical expenses and you pay the other 20% after any applicable deductibles have been met. The coinsurance helps in keeping the cost of insurance down and helps to keep your premiums affordable. Most plans will also have a limit on the amount of coinsurance you have to pay in a calendar year.
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Up to what age can I cover my children as dependents on my coverage?
Most health plans cover dependent children up to age 19. After that, if the child is still attending full-time school, the coverage may be continued up to age 23. Each carrier determines the age in which a full-time student can be covered and some plans will cover the child until the age of 25..
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Why do I need a referral from my doctor for treatment by a specialist?
You need your doctor’s referral for any type of treatment, not only specialist consultants. Your doctor’s recommendation is required for prescriptions, X-rays and lab tests, hospitalization and surgery.
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My spouse and children are covered under my health plan. Should we also enroll in the health plan through my spouse's employer?
First you must compare the cost of additional premiums to the benefit you would receive if you had secondary coverage. You can definitely enroll in both plans; however, if your employers do not contribute towards the cost of dependent premiums it may be cost prohibitive. Also, secondary coverage will not pay a higher
benefit than your primary coverage and you can still incur out-of-pocket expenses.
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How long after my treatment do I have to submit my claim to my insurer?
Most health plans allow a period of 90 days from the start of your illness for you to submit a claim. If your treatment is prolonged, you should notify your insurer that you are undergoing treatment.
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What is a pre-existing condition?
A condition, which existed before the insurance policy was effected. If you do not have prior coverage, an insurance company can elect to not cover those conditions untill you have been insured with them for a specific period of time.
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What is Usual, Customary, and Reasonable Charges (UCR)?
In the insurance world, a popular phrase considers whether or not a particular fee charged by a physician, dentist, or other health professional is “usual, customary, and reasonable,” or “UCR.” As a consumer, it’s important to understand these terms, since they can affect insurance reimbursement and additional out-of-pocket charges that you might have to pay. The following tips provide useful information about “UCR’s.” Usual: A charge is considered “usual,” if it is a physician´s usual charge for a procedure. Customary: A charge is considered “customary,” if it is within a range of fees that most physicians in the area charge for a given procedure (often measured at a specific percentile of all charges submitted for a given procedure in that community). Reasonable: A charge is considered “reasonable,” if it’s usual and customary or if it’s justified because of special conditions.
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