To help my friends be savvy healthcare consumers.

Learn more here: http://www.insideworkplacewellness.com

Your monthly cost for coverage. Your premium will generally have an inverse relationship to your deductible.

In-network providers negotiate a contract with an insurance network that specifies what they will be reimbursed for providing services to patients that are members of that network. They agree to accept the agreed upon reimbursement amount as payment in full for their services.

Out-of-network services are those provided by physicians or other health care providers that have not entered into a contract with the health insurer to accept discounted rates.

The amount a member must pay out-of-pocket for services before the insurer will start making payments for covered services. A deductible is typically set on an annual basis.

The maximum you will be required to pay during a calendar year. After you reach this amount, your insurer will cover all your eligible expenses.

Usual, Customary and Reasonable (UCR) - Before managed care became common, medical service providers typically charged insurers a retail, non-discounted rate for services. The concept of usual, customary and reasonable rates was developed to protect against providers engaging in fee gouging. Health insurers generally calculate coverage for out-of-network benefits based on a percentage of UCR rates.

Balance billing is when a provider of a medical service bills the patient for the difference between the provider’s actual charges and the amount the provider is reimbursed from the patients insurance benefit plan. This commonly occurs when a patient seeks services from an out-of-network provider, but has been prohibited by the contracts governing the relationship of in-network providers.

Coinsurance is your share of the costs of a health care service. It’s typically stated as a percentage of the amount the provider contracts with the carrier to reimburse for a service or the UCR.

A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.

The average cost of care varies dramatically from one center of care to another. This may weigh more heavily in your decision making if you have a high deductible health plan.

Convenience Care Clinic $50
Provider's Office $70
Urgent Care Center $130
Emergency Room $850

Our neighborhood minute clinic is:

Inside CVS/pharmacy #1402
1062 Elden Street
Herndon, VA 20170

Learn more here: http://www.insideworkplacewellness.com/2013/02/where-to-seek-care.html

Covered in full and not subject to a deductible. However, claims will be processed based on the codes your provider submits to the insurance company. If they code the visit as anything other than well care, you may be billed.

The cost of lab services varies dramatically from one provider to the next. Use the tools your plan provides to compare your costs. For example the average cost of an MRI scan of the knee without contrast in zip code 20194 was is $1,498 on 1/16/14, but the range was huge -- some providers charged as little as $187.

May only be covered for certain conditions. For example, speech therapy for development disabilities is often excluded. There may also be a limit on the number of visits covered.

Durable Medical Equipment (DME) medical equipment used in the home like crutches, wheel chairs and diabetic testing supplies.

Mental health care must be covered like medical care, but most networks have a very limited number of in-network providers.

Research your drugs. Talk with your doctor about effective, but less expensive alternatives. Use mail order. More info here: http://www.insideworkplacewellness.com/search?q=how+to+save+money+on+prescr...

The NurseLine is a great first point of contact for people with a health concern. A team of experienced registered nurses is available to answer health questions 24 hours a day, seven days a week at no cost to the caller. They're available at 2:00 am when a child has a high fever. They can help a caller decide when a family member might need stitches or an x-ray. When someone is traveling and gets sick, they can help the person decide when and where to seek care.

If your employer offers an FSA, you can put up to the allowed amount ($2,500 maximum) into the account pretax and use it for the medical expenses for you and your tax dependents during that calendar year. You'll forfeit any money you don't use.

Think of a HSA like a 401k for your health care expenses. You put money into an HSA just like a 401k. It's withheld pretax from your pay checks. You choose how to invest the balance in your account and it grows tax free. You then use the money in the account to pay for your deductible and any health care costs that aren't covered by our health plan. (The same kind of things you might use your FSA to pay for now.)

To open an HSA you must be part of a HDHP. For 2014, the deductible on an individual policy must be at least $1,250 and it must be at least $2,500 on a family plan. An individual can contribute $3,300 a year and a family can contribute $6,550.

You can keep your kids on your plan until they turn 26, but you can only use money in your HSA to pay their expenses as long as you can claim them as a dependent on your taxes.

If you or your children are traveling out of the country, I recommend purchasing a separate travel health care policy for them. More info here --

http://www.insideworkplacewellness.com/2012/04/ten-health-care-travel-tips....

If you seek services from an in-network provider (doctor or hospital) and they use an out-of-network lab or anesthesiologist unbeknown to you, you will likely get a bill applying the services to your out-of-network benefits. Appeal the decisions. Start with a phone call to your insurance company. If they don't reprocess the claim at your request, send an appeal letter.

Helpful resources here:

http://www.insideworkplacewellness.com/2013/10/estimating-your-health-care-...

During your plan administrators open enrollment period and when you have a qualifying event. Qualifying events include:

- Change in marital status.
- Change in number of dependents.
- Change in employment.
- Change in dependent eligibility due to plan requirements (e.g., loss of student status, age limit reached).
- Change in residence (e.g., employee or dependent moves out of plan service area).
- Significant cost changes in coverage.
- Significant curtailment of coverage.
- Addition or improvement to benefit package option.
- Change in coverage of spouse or dependent under another employer plan (e.g., spouse’s company had no insurance coverage before but now offers a plan).
- Loss of certain other health coverage (e.g., plans provided by governmental or educational institutions).
- HIPAA special enrollment right events.
- Judgments, decrees, or orders.
- Entitlement to Medicare or Medicaid.