Navigating Healthcare and Insurance Benefits

Sometimes we could use a little help understanding our coverage and benefits.



When we go to the doctors’ office, we tend to expect that they will know our benefit plan or health insurance coverage. As a patient, it is your responsibility to understand what your health insurance covers and what it doesn’t cover. When you enroll into a health insurance plan, whether it is through your employer group, or Medicare or the Affordable Care Act, knowing your full benefit coverage is necessary, and empowers you as the patient. Here are a few tips to keep in mind:


  1. Review your Summary of Benefits and Glossary of terms. This document will help you understand important features of your plan and what out of pocket costs you would be expected to pay. If you don’t have a copy readily available, you can always go on-line to the insurance company’s website to gain this information. If you are an employee, and benefits are through your employer, you can always consult with your HR Department.

  2. Read all forms thoroughly at the providers office before signing. If you don’t understand the document, wait until your concerns or questions are fully addressed by the provider office or your insurance carrier. If you sign a form and are not absolutely sure what it means, you may be agreeing to pay for services rendered without realizing, or more importantly giving access to your medical record by a third party.

  3. Keep copies of everything, including any communication from your health plan or provider. Prior authorization forms are important and help in the event that the coverage was later denied by your health insurance provider. Evidence of Benefits or Explanation of Benefits (EOB) is important to keep for reference back to exactly what is or not covered. Other samples of copies to retain would be medical bills, documents of conversations, etc.

  4. Talk to your healthcare provider about your health concerns. In the event you do not feel comfortable with the office visit or the direction of your healthcare provider, you can seek a second opinion. Often time, communicating to your provider can help clarify and resolve your concerns. However, if you disagree, you could be entitled to a second medical opinion. Make sure this is covered first, as you don’t want to get in a bind paying for a large bill.

  5. You want to be sure your provider has your most current and up to date insurance card and health plan information. Plan benefits can change and our providers have no idea. It is your responsibility as a patient to keep them informed of your health insurance and contact information.

When in doubt, you can always reach out to your HRBC agent of choice to help navigate through some of these concerns. Call us with any questions you may have about your healthcare coverage and options! 1-877-651-7526 TTY: 711

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