How to avoid surprises from your health plan, part 3: Make smart decisions

Surprises from your health plan aren’t something you enjoy—or that anyone enjoys. Here are a few tips on how you can prevent the unexpected from your health plan. This is the third post in a series about things you can do to control your health care costs better and avoid surprises later. Check out the first post and the second post for more tips.

Avoid going out of network

Most health insurance companies negotiate discounted rates for their plans with the health care providers in their network. To find out if the doctor you want to see is in the network, contact your insurance company. Most insurers have online lookup resources for your convenience. If you use an out-of-network doctor or hospital, the costs can vary a lot. You might end up footing most of the bill or maybe even the entire bill. So if you need to go out of network, make sure you don’t have another in-network option, do some research, and then negotiate with the provider.

When might you need to go out of network? Well, if you need to see a certain type of specialist and don’t like the one in your network, you might decide the out-of-network choice is best.

Watch out for accidentally going out of network. Your in-network doctor might unknowingly refer you to an out-of-network specialist. Also, some providers in your in-network hospital, such as anesthesiologists or radiologists, might not be part of your network. Always ask the provider or hospital to find out for sure.

Shop around for prescription drugs

Prescription drugs can be expensive if you have drug copays—especially the name-brand ones for which there is no generic option. So shop around! Prices vary from pharmacy to pharmacy and you might get the best prices at a discount store or through a price club. You’ll save more if you use an in-network pharmacy.

Ask for generic versions of drugs whenever they’re available. They are formulated with the same active ingredients as their branded counterparts.

You might also be able to save money by ordering your medications online or by mail order. Some large drugstore chains have websites that offer savings. You’ll find a complete list of websites on the National Association of Boards of Pharmacy (NABP) site. Look for websites that display the NABP VIPPS (Verified Internet Pharmacy Practice Sites) seal, which means they meet state and federal requirements.

Read the article on reducing medication costs in our Health Center for more information. For more information on picking a health plan, take a look at our page on Getting the Most from Your Health Plan.

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