January 2019


What's New at  

Guardian Nurses?


    Health Insurance 101       


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What's New at Guardian Nurses 
Welcome to the Team!
As we look ahead to 2019, we want to acknowledge, too, that 2018 was a very busy year for Guardian Nurses. It was a year of growth, expansion and lots of great memories.   
We've added some great nurses to our team.   
Alicia Rogers 
Jeanette Meredith
Melissa Dominguez 
Lori Fitzpatrick
Colleen Pace
Jasmin Rivera
Rachel Fanslau 
Happy and Healthy New Year to you!! 
We recently received a call from a client who had multiple claims and didn't understand why his health insurance company did not pay everything. He had very little understanding of his benefits or the cost of care. His plan had a $5,000 deductible which meant that the insurance company would not pay until his family met that deductible.  That's a tough pill to swallow. 
It is a fresh, new year. And lots of things renew---like maybe your health insurance coverage.  Most Americans give more attention to planning their vacation than understanding their healthcare plan. They trust that the employer is giving them all the information they need and that the plan will cover all their healthcare needs. Every year millions of dollars are paid by consumers that was not their responsibility to pay all due to lack of understanding of their insurance plans.
Consider this month's issue of The Flame your Insurance 101 Primer!    
 Betty Long, RN, MHA
      Guardian Nurses Healthcare Advocates
In this New Year issue of The Flame, we want to give you some very basic understanding of health insurance as well as some resources to help educate yourself. 
  1. First things first.  Obtain a copy of your benefit summary. You usually can get this from your Human Resources office. Or when you have an hour to kill, call your health insurance company and ask them for it.
  2. Consider registering on the insurance company's portal so you can obtain pertinent information about your coverage.
  3. Know what type of health insurance plan you have: PPO, EPO, HMO
    1. PPO: Preferred Provider Organization.  This type of plan allows members choices of lower-cost providers when choosing those within the network. Does not require a referral to see specialist. Typically offers partial coverage of out of  network providers and services.
    2. HMO: Health Maintenance Organization. This is a managed care health plan which requires you to choose a approved primary care provider who is the gatekeeper for additional treatment/services. Requires referral from primary care provider for all specialist visits.
    3. EPO is an Exclusive Provider Organization and this plan offers no out of network benefits. Must choose provider and services from the Exclusive provider list or pay out of pocket.
    4. The Benefit Summary Glossary
      1. Deductible: If your plan has a deductible this is typically the amount of money that you must pay BEFORE the insurance plan starts to pay for services.
      2. Co-Insurance: This is a percentage of cost that you are responsible for paying. (Example: Insurance plan covers 80% of hospital cost and you are responsible for 20% of the cost)
      3. Co-Pay: Set amount that is paid at the time of a service. (Example: Doctor's office visit-$20 co-pay)
      4. In Network versus Out of Network.
      • In Network.  Insurance companies set up contracts with providers to be part of their network.When you go to one of these providers, the cost of care is based on a negotiated price and is usually covered at a higher limit.  Sometimes it's even covered in full.
      • Out of Network. If your policy allows you to use providers who are not in their network, it will only cover a percentage of the cost.  The provider can then bill you for the difference. (This is "balance billing.")
      5. The Explanation of Benefits. This is a document that is provided to you by the insurance company. It is NOT a bill. It shows how a claim was processed and is very important to review.  When you are provided services by a healthcare provider, they submit a claim for payment to your insurance company. The insurance company processes the claim and pay what is allowed based on your benefits. In order to make sure that no mistakes were made, we strongly suggest that you review this closely.
  1. Options to help pay the uncovered cost of services.
    1. HSA--Health Savings Account: A savings account with tax advantages that is offered in combination with High Deductible Health plans. The funds that are accumulated can be used for eligible medical expenses. Some employers add funds to these along with the employee. The money invested can grow tax-free and can be accumulated over time with no limit to the yearly contribution. You benefit by lowering your taxable income since the deduction is done pre-tax.
    2. FSA--Flexible Spending Account: Usually offered as part of a benefit package. A self-determined pre-tax contribution is placed in the account which can be used for non-covered healthcare costs. *Expires at the end of the year* (Use or lose). You benefit by lowering your taxable income since the deduction is taken pre-tax.
Insurance policies have a lot of pieces and can be very confusing (I think they're purposely written to be confusing). But it is infinitely better for you as a healthcare consumer to know your plan BEFORE you incur charges. If you get your insurance from your employer, call your HR department and make sure you understand how to work within the limits of the plan so that you aren't stuck with a huge bill.
To learn more, go to the Healthcare.gov website which includes videos, articles and booklets that you can access for free to provide a better understanding of healthcare coverage and terminology.  And if you're now thoroughly confused, reach out to Guardian Nurses!
With thanks to Denise Marceron, RN

Guardian Nurses Healthcare Advocates

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