Get the most from your doctor's visit

Step 1: Prepare

• Save money by using an in-network doctor.
• Save the ER for emergencies only. Review your plan information or call you doctor for help on where to go for non-emergency situations.
• Bring your ID card to your appointment.
• Be willing to see a physician’s assistant or a nurse for routine care like wellness
  check-ups and immunizations.
• Have a list of questions ready to ask your doctor.
• Don’t wait until the end of a visit to mention a pressing health concern.

Step 2: Communicate

• Be honest about your lifestyle. If you smoke or drink alcohol tell your doctor how often
  or how much.
• Share your personal and family medical history, including illnesses, operations, and diseases of your parents, grandparents and siblings.
• Maintain an updated list of the medications, over-the-counter drugs, and supplements you take and their dosages. Bring the list to your appointment.

Step 3: Take Action

• Write down what the doctor says about your condition and how to treat it.
• If you are prescribed medication, ask if a generic drug is available rather than
  a brand-name prescription drug.
• Ask if the doctor uses e-mail. If so, use e-mail to discuss non-urgent matters, to clarify treatment instructions, or to report an improvement in symptoms. But call your doctor’s office immediately if your symptoms don’t improve as expected.
• Get an independent second opinion if you are told that you have a life-threatening condition, if surgery is needed, or if you are doubtful about the quality of tests
  that were done.

Using the ER for everyday medical care can really cost you

It is Sunday afternoon and you just hurt your ankle. It is painful and swollen. Do you go to the ER? While the ER may be the first place that comes to mind to receive urgent care, waiting room lines can be long if it’s not a true emergency. Also, because you pay a portion of the bill, going to the ER may mean unnecessary out-of-pocket costs for you.

Be sure you get the right care you need – at the right place

Check your plan in advance to see what emergency services and after-hours care your doctor offers. In the case of an emergency, call your doctor or your health plan’s 24-hour nurse line. He or she will help you determine when the emergency room is the right choice.

Some reasons to be treated in the emergency room or to call 911 include:

• Chest pain or squeezing sensation in the chest
• Trouble breathing
• Very high fever
• Deep cut or bleeding that won't stop
• First time seizure
• Severe seizure
• Broken bone
• Major injury, such as a car accident
• Unconsciousness, unusual sleepiness or confusion
• Abuse (beating, stab wound or gun shot wound)
• Uncontrolled bleeding
• Shortness of breath
• Suspected overdose of medication or poisoning

Save time and money when you visit an urgent care center or walk-in clinic

Save the emergency room for emergencies. Urgent care centers or walk-in clinics can provide care for your minor illnesses and injuries.

Consider going to the urgent care if you have the following symptoms:

• Earache
• Toothache
• Rash
• Colds, cough, sore throat or flu
• Stuffy nose, sinuses
• Minor cooking or household burn
• Sunburn
• Back pain that you have often
• Minor headache
• Broken cast
• Teething baby
• Stitches that need to be taken out
• Medicine refills
• Child or infant fever

You do the math!

Sydney, a 25-year-old female, has a cold and goes to her doctor's office. The total bill is $116.57. If she would have gone to the ER, her total bill would have been $403.49. See the chart below that demonstrates the savings of going to your doctor for non-emergency problems. The savings may be bigger than you might expect.

 

Dollar amounts listed may not reflect actual billed charges. This document is to be used for illustration purposes only. It is not a guarantee of payment, as actual claims submitted may differ from the amounts reflected. Your savings may vary. May not be available in all states. Underwritten by Connecticut General Life Insurance Company. “CIGNA” is a registered service mark, and “CIGNA HealthCare Voluntary Limited-Benefit” is a service mark of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. Products and services are provided by such operating subsidiaries and not by CIGNA Corporation.

Use in-network doctors, hospitals and facilities

It's important to know that in-network doesn't just apply to doctors.

Health plans negotiate rates with certain doctors, hospitals and facilities. When you use in-network health care professionals, you can save a lot. When you don’t, you often have to pay a higher amount. Additionally, you may have to pay any difference between your health plan’s maximum reimbursement amount and your doctor’s charges.

It’s important to know that the in-network concept doesn’t just apply to doctors. So if your doctor recommends that you visit a specialist, or sends you for a test or a hospital visit, you’ll want to make sure that the facility or hospital you go to is in your health plan’s network. You can find out which doctors and facilities are in-network by calling your health plan or checking their website.

Flu Example

This example shows how your total bill is affected by the cost of a doctor’s visit. Jenna and John both have the flu. Jenna visits an in-network doctor and John an out-of-network doctor. As you can see, it costs less to use an in-network doctor than an out-of-network doctor.

See the tab How to Budget for more information.

 

Dollar amounts listed may not reflect actual billed charges. This document is to be used for illustration purposes only. It is not a guarantee of payment, as actual claims submitted may differ from the amounts reflected. Your savings may vary. May not be available in all states. Underwritten by Connecticut General Life Insurance Company. “CIGNA” is a registered service mark, and “CIGNA HealthCare Voluntary Limited-Benefit” is a service mark of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. Products and services are provided by such operating subsidiaries and not by CIGNA Corporation.

How do I budget for my out-of-pocket expenses?

Step 1: To begin having access to health coverage, you pay a premium, the amount you pay for your health plan. Some employers deduct the premium from your paycheck so you don’t have a separate bill to pay each month.

Step 2: Before you even arrive at the doctor’s office, health insurers have negotiated a network discount for you. Many doctors offer discounts of up to 50% off of their usual charges. Using an in-network doctor can save you money because you’ll get more services without using up all of your benefits.

Step 3: On the day of your doctor’s visit, you show your health insurance ID card and pay a co-pay for the visit. Many plans have a co-pay of $10-20. Once you pay the co-pay, your health plan pays 100% of your costs until you reach the benefit maximums. 

6 ways to budget

• Develop a monthly spending plan for you and your family’s expected health care costs.
• Get into the habit of saving your health care receipts and tracking your expenses along with your regular monthly bill paying.
• Keep your receipts in one envelope labeled "health care expenses." At the end of the year, you will be able to calculate exactly what you spent on health care expenses for the previous year.
• Compare doctor costs and try to stay in-network to make the most of your plan maximum.
• Remember that your medical benefits maximums start over each year
• Remember that you pay the same price for your premium until your annual group renewal. Section 125 plans do not allow you to make changes to your benefits, other than during Open Enrollment or for a qualified life event such as getting married or having a baby.

How can I maximize my benefit dollars?

This example shows how your annual benefit maximum is affected by the cost of a doctor’s visit. Jenna and John both have the flu. Jenna visits an in-network doctor and John an out-of-network doctor. As you can see, it costs less to use an in-network doctor than an out-of-network doctor.

Flu Example

Jenna: Jenna has the flu and goes to a network doctor. Once she paid her $15 co-pay, Starbridge pays the remainder $185, for a total bill of $200. The $185 that Starbridge pays is taken from her annual benefit maximum amount paid by her plan.

John: Compare how much John has remaining for the year after he has the flu and goes to an out-of-network doctor. After he pays his $15 co-pay, Starbridge pays $335 because his doctor was not in-network. Instead of having $815 left for the remainder of the year, John has $650 left for the rest of the year for outpatient care. 

 

It is less expensive for you to see an in-network doctor because the doctor is contracted with your health insurance company. After your visit, the doctor’s office will send a claim to the insurance company for the cost of the appointment.

 

Dollar amounts listed may not reflect actual billed charges. This document is to be used for illustration purposes only. It is not a guarantee of payment, as actual claims submitted may differ from the amounts reflected. Your savings may vary. May not be available in all states. Underwritten by Connecticut General Life Insurance Company. “CIGNA” is a registered service mark, and “CIGNA HealthCare Voluntary Limited-Benefit” is a service mark of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. Products and services are provided by such operating subsidiaries and not by CIGNA Corporation.