Health Insurance continues to be a very complex, difficult to understand, and in many instances less than a transparent entity.
This episode explores health insurance from multiple perspectives (individuals, employers, health care providers, and care delivery organizations.
The role of Pharmacy Benefit Managers (PBM’s) is also explored.
Dr. Jeffrey Frankel, MD, Is a Past President of the Washington State Urology Society, a Past President of the Western Section of the American Urological Association, a Past President of the American Association of Clinical Urologists, and he currently chairs the Government Affairs Committee for the Washington State Urology Society He has practiced Urology in the King County area since1985.
During This Episode, We Discuss:
What is your responsibility regarding your insurance coverage prior to visiting a medical provider’s office, undergoing a procedure study, or surgery?
How does your coverage differ from someone else who might be under the same plan?
What happens when you are in Network or out-of-network? What does that mean?
What happens when your care provider becomes employed by a healthcare entity, clinic, or insurance company
How do Medicare, and Medicaid work? How is it different from private insurance?
What are Medicare Advantage plans?
What are Pharmacy Benefit Managers?
Medicare Advantage plans are a form of Medicare, approved by the government, and put out by insurance companies….. If you go with an advantage plan, they pick a system and your provider may not be part of that plan or system.
You have to be quite careful when you sign up for a plan with a lower/ less expensive premium… as there are consequences for that lower premium cost such as restrictive access to care and they also deny more procedures and prescriptions.