What is a Healthcare Navigator?

The healthcare system is complicated. We all know it. When making a decision about your care, there is a plethora of resources available, but determining the right ones can be very overwhelming.

For people who have a medical professional in their family, they can count on them to direct them to the best care and to guide them through medical decisions. But who can people who do not have a doctor or nurse in their family turn to for advice? It is this question that Rightway’s dedicated clinical Navigator answers.

 

alt="patient healthcare navigator"

 

Healthcare Navigators are professionals trained to help consumers navigate through the US healthcare system. Their goal is to help you make the best healthcare decisions possible. Whether that means picking the plan that best suits your lifestyle, preparing for a surgery or procedure, or finding top in-network doctors; there’s someone who is trained to help you do just that. A Healthcare Navigator also aids in logistical aspects and helps manage complicated care regimens.

 

Overview

The healthcare system is like a maze, which often leads individuals to several dead ends. A Navigator’s job is to guide you on the right path so that you aren’t led astray by private interests or by profit-motivated individuals.

So let’s dive into more specifics, the different roles that employer and patient healthcare navigators can fulfill, and how they can help you access better healthcare.

 

alt="clinical patient health navigator"

 

But Just What is a Healthcare Navigator Exactly?

They are experts in the health space. The best Navigators have years of clinical experience as doctors or nurses and have help from Health Assistants who have backgrounds in healthcare policy and claims. Their main purpose is to assist members with coordinating care, understanding benefits, and resolving bills. Navigators are required to be unbiased, and their services are free to members as a part of their company’s benefits.

Healthcare Navigators explain how health insurance plans work to their beneficiaries and purchasers. They help them understand their plans and how to find the plans best suited to them.

When it comes to enrollment, there are different ways of applying for health insurance. Two of the standard ways is through paperwork or applying online. Health navigators can help with both, not only with establishing eligibility but also in potentially qualifying you for insurance affordability programs.

Navigators are advocates that mentor you about your benefits, conditions, bills, and all other healthcare needs. If necessary, they can also refer members to additional employee assistance programs.

 

The Clinical Space

Healthcare Navigators also have several duties in the clinical space. These duties include helping members get access to treatment, helping them understand diagnoses and treatment options, as well as analyzing and understanding your healthcare plan so that you don’t have to.

Navigators are concierges that are dedicated to each member. That means every time you call or message your Navigator, you will talk to the same person and they will have files of your preferences and applicable medical information. They are armed with data and analytics to proactively engage you on issues that can improve your health. For instance, they will review blood pressure numbers you convey to them and help you find a Cardiologist if need be.

This has huge implications for patients. When care is given proactively, is patient-centered, and preventive, healthcare providers will be able to spot symptoms in patients earlier as well as provide them with more efficient care. Most major conditions can be prevented through early intervention and patient healthcare navigators are there to make sure all necessary preventive care steps are taken to keep members healthy.

Using Healthcare Navigation Companies For Out-Of-Network Care

If you have engaged with the healthcare system for more than routine checkups, you have probably received a bill you don’t understand. Often, this is because the provider you visited was out of network, the procedure you received was not covered by your insurance plan, or simply the code your doctor entered in your invoice was incorrect. Below are some common instances that can result in an unexpected bill and ways to avoid pitfalls. RightWay Healthcare navigation can help skip the headache.

 

alt="healthcare navigation companies"

Going Out Of network

Going out of network can happen either intentionally or unintentionally. You might be forced under certain circumstances, or you may face unexpected hospital bills from a provider who turned out to be from out of network. 

Circumstances for choosing to go out of network include the following: 

 

Preferred Doctor

Your doctor, who was once in-network decided to opt-out of your network, but this is a doctor that you trust to do the best job. She might be your obstetrician, and there’s no one else you would trust more to deliver your baby. You are willing to pay more out of pocket for this service.


Referral
 

You may get a referral from your surgeon, who is in your network, to go to a radiologist, who is not in your network. After getting your X-rays done, you get a bill from your radiologist that you have to pay out of pocket.

 

Unexpected Costs

The fine print in most can healthcare plans catch people by surprise. For example, in your insurance plan hospital expenses are (seemingly) covered. So you go to the hospital and end up in a private room, which is the only room available at the time. Later on, when the bill arrives, you find out that your insurance company doesn’t actually provide coverage for “private rooms.” You end up having to pay the same amount as you would if you didn’t have any insurance at all. 

So we see the problem with out-of-network services. If you talk to your Healthcare Navigator before seeing a doctor, having a procedure, or visiting the hospital, they will direct you to the best care accessible in your network. Here are some things they can do to ensure you will not get hit with an unexpected bill:


1) Confirm With Your provider

The purpose of contacting your provider is to verify what insurance they accept. While a provider’s website may list common insurance they accept, that may not include your specific insurance plan even if the company is listed. Navigators know the intricacies of each plan, what should be covered, and what questions to ask. They will confirm with the provider that they are covered under your specific insurance policy.


2) Review The Costs With You

Even if a provider is in-network, there are often costs you will still need to cover, such as a co-pay. Healthcare navigation companies can walk you through these costs. They may be simple, such as a $20 flat fee for all specialist visits. But they could be quite complicated such as 20% up to $3,000, 15% from $3,000 – $6,000 and free for anything over that amount. They will walk you through the breakdown and the amount you should expect to pay depending on the procedure.


3) Be Vigilant For Surprise Costs

Your doctor might be covered, but don’t assume that anything your doctor orders for you will be covered as well. When she sends you to the lab in the other part of the hospital for a blood test, that service might not be covered under your insurance plan. If anything comes up during a visit, you can always call or chat your Navigator to understand the associated fees and if there are any cheaper options. For instance, it might be significantly less to get a blood test done at a freestanding facility versus at the hospital.


4) Look Into Gap Coverage

If you know that you will need a special service that’s out of network, they can work with you to arrange for that coverage ahead of time. Even if the provider or facility doesn’t normally provide coverage for that service, there may be a way to persuade your insurance company to cover it in the case of a special circumstance. 

Rightway is a healthcare navigation company that is here to make sure that your care is covered. If you ever get a bill you don’t understand, you can send them a photo of it and they will walk you through it. If there are issues, they will contact your providers and insurance to advocate on your behalf and correct any discrepancies in the billing process.

 

 

How to Select Health Insurance

Once a year, your company has an open enrollment period in which you select your health insurance plan for the coming year. This time can be stressful for many people as figuring out how to balance premiums, deductibles, and copays can be tricky.

Professionals can often make the wrong decision about choosing their healthcare plan. Even if you do everything right by researching different plans, confirming that your doctors are in-network, and reviewing prescription limitations; something may still go awry. For example, some plans have a tiered network of providers: tier 1, tier 2, tier 3, etc. In this case, you’d have to make sure that your doctors were in an appropriate tier that matches your budget.

Health insurance can be stressful to understand, and many worry they are not making the right decision on which plan to choose. Here are five tips to help you find the right health insurance plan.

 

 

Make Sure to Read Through All the Changes

Even if you are comfortable with the plan you were on the past year, it is important to consider other possible plans with a better value for your money.

It may be tempting to skip the open enrollment process but know that there may be changes to the plan you were on. Even if your household income hasn’t changed, your plan will likely update automatically. Policies and premiums are not guaranteed to stay the same forever.

The beginning of the year is known to shake things up for consumers, and the insurance industry is no exception. In fact, this year the amount of new insurers entering the market is driving down the cost of premiums in some states; yet another good reason why you should check back in and see what plans are available.

 

Look at the Estimated Yearly Expenses, Not Just Monthly Premiums

When looking at the estimated yearly cost you also have to take the deductible and copayment amounts into account.

The premium is usually put front and center when looking at plans, but there are some online tools to help you calculate the estimated yearly expenses. You can look at HealthCare.gov or certain state marketplaces. The estimated yearly expenses are calculated based on all the different factors, including copays, deductibles, and the amount of healthcare you expect to receive in the upcoming year.

These kinds of tools can be extremely useful when choosing a plan. The math can be tricky to work out with all the different variables involved.

 

alt=“health patient navigator”

 

Determine How Much You Typically Spend on Healthcare

The amount of healthcare you expect to receive can be difficult to determine. The amount will indeed affect the price and is a prime factor in choosing the right health insurance plan near you. While age is a useful thing to consider, you must also account for the possibility of accidents (auto, workplace injury, unexpected diagnosis, etc). Think through all the ways you consume healthcare – from specialists to prescriptions – and which plans best support those use cases.

 

Decide What Your Priorities Are

What it really comes down to:

  • Do you want to pay a slightly higher monthly premium and have a decreased out-of-pocket expense limit?
  • Or do you want to pay a lower monthly premium with higher out-of-pocket expenses? In this case, incidents can be quite costly but there is still the peace of mind of staying insured.

Besides these general considerations, you should also take your specific health needs into account. Are your current prescriptions and favorite doctors covered under the potential plan? Many companies have a search tool for doctors and prescriptions they cover and providers often list what insurance carries they accept.

alt=“family health insurance”

Health Navigators are Available to Help You

Your employer may offer a healthcare navigation platform – such as Rightway. Navigators are clinicians with expertise in healthcare policy to help you with all decisions you need to make around your health and wellness. Not only can Navigators help you find providers and schedule appointments, but they can also explain the plan options to you and help determine which plan is best for your needs.

The main benefit of working with a health navigator is impartial advice. They look for the plan that’s best for you.

Rightway Navigators are available to members through phone or chat in the Rightway app to answer your open enrollment questions. Not sure if you have access to Rightway? Ask your company’s HR director if Rightway is included in your benefits package. 

 

© 2019 Rightway Healthcare.
employees
Download our free mobile app
Google Play
Get it on
employees
App Store
Download on the
icon
healthcare

What is a Healthcare Navigator?

The healthcare system is complicated. We all know it. When making a decision about your care, there is a plethora of resources available, but determining the right ones can be very overwhelming.

For people who have a medical professional in their family, they can count on them to direct them to the best care and to guide them through medical decisions. But who can people who do not have a doctor or nurse in their family turn to for advice? It is this question that Rightway’s dedicated clinical Navigator answers.

 

alt="patient healthcare navigator"

 

Healthcare Navigators are professionals trained to help consumers navigate through the US healthcare system. Their goal is to help you make the best healthcare decisions possible. Whether that means picking the plan that best suits your lifestyle, preparing for a surgery or procedure, or finding top in-network doctors; there’s someone who is trained to help you do just that. A Healthcare Navigator also aids in logistical aspects and helps manage complicated care regimens.

 

Overview

The healthcare system is like a maze, which often leads individuals to several dead ends. A Navigator’s job is to guide you on the right path so that you aren’t led astray by private interests or by profit-motivated individuals.

So let’s dive into more specifics, the different roles that employer and patient healthcare navigators can fulfill, and how they can help you access better healthcare.

 

alt="clinical patient health navigator"

 

But Just What is a Healthcare Navigator Exactly?

They are experts in the health space. The best Navigators have years of clinical experience as doctors or nurses and have help from Health Assistants who have backgrounds in healthcare policy and claims. Their main purpose is to assist members with coordinating care, understanding benefits, and resolving bills. Navigators are required to be unbiased, and their services are free to members as a part of their company’s benefits.

Healthcare Navigators explain how health insurance plans work to their beneficiaries and purchasers. They help them understand their plans and how to find the plans best suited to them.

When it comes to enrollment, there are different ways of applying for health insurance. Two of the standard ways is through paperwork or applying online. Health navigators can help with both, not only with establishing eligibility but also in potentially qualifying you for insurance affordability programs.

Navigators are advocates that mentor you about your benefits, conditions, bills, and all other healthcare needs. If necessary, they can also refer members to additional employee assistance programs.

 

The Clinical Space

Healthcare Navigators also have several duties in the clinical space. These duties include helping members get access to treatment, helping them understand diagnoses and treatment options, as well as analyzing and understanding your healthcare plan so that you don’t have to.

Navigators are concierges that are dedicated to each member. That means every time you call or message your Navigator, you will talk to the same person and they will have files of your preferences and applicable medical information. They are armed with data and analytics to proactively engage you on issues that can improve your health. For instance, they will review blood pressure numbers you convey to them and help you find a Cardiologist if need be.

This has huge implications for patients. When care is given proactively, is patient-centered, and preventive, healthcare providers will be able to spot symptoms in patients earlier as well as provide them with more efficient care. Most major conditions can be prevented through early intervention and patient healthcare navigators are there to make sure all necessary preventive care steps are taken to keep members healthy.

Using Healthcare Navigation Companies For Out-Of-Network Care

If you have engaged with the healthcare system for more than routine checkups, you have probably received a bill you don’t understand. Often, this is because the provider you visited was out of network, the procedure you received was not covered by your insurance plan, or simply the code your doctor entered in your invoice was incorrect. Below are some common instances that can result in an unexpected bill and ways to avoid pitfalls. RightWay Healthcare navigation can help skip the headache.

 

alt="healthcare navigation companies"

Going Out Of network

Going out of network can happen either intentionally or unintentionally. You might be forced under certain circumstances, or you may face unexpected hospital bills from a provider who turned out to be from out of network. 

Circumstances for choosing to go out of network include the following: 

 

Preferred Doctor

Your doctor, who was once in-network decided to opt-out of your network, but this is a doctor that you trust to do the best job. She might be your obstetrician, and there’s no one else you would trust more to deliver your baby. You are willing to pay more out of pocket for this service.


Referral
 

You may get a referral from your surgeon, who is in your network, to go to a radiologist, who is not in your network. After getting your X-rays done, you get a bill from your radiologist that you have to pay out of pocket.

 

Unexpected Costs

The fine print in most can healthcare plans catch people by surprise. For example, in your insurance plan hospital expenses are (seemingly) covered. So you go to the hospital and end up in a private room, which is the only room available at the time. Later on, when the bill arrives, you find out that your insurance company doesn’t actually provide coverage for “private rooms.” You end up having to pay the same amount as you would if you didn’t have any insurance at all. 

So we see the problem with out-of-network services. If you talk to your Healthcare Navigator before seeing a doctor, having a procedure, or visiting the hospital, they will direct you to the best care accessible in your network. Here are some things they can do to ensure you will not get hit with an unexpected bill:


1) Confirm With Your provider

The purpose of contacting your provider is to verify what insurance they accept. While a provider’s website may list common insurance they accept, that may not include your specific insurance plan even if the company is listed. Navigators know the intricacies of each plan, what should be covered, and what questions to ask. They will confirm with the provider that they are covered under your specific insurance policy.


2) Review The Costs With You

Even if a provider is in-network, there are often costs you will still need to cover, such as a co-pay. Healthcare navigation companies can walk you through these costs. They may be simple, such as a $20 flat fee for all specialist visits. But they could be quite complicated such as 20% up to $3,000, 15% from $3,000 – $6,000 and free for anything over that amount. They will walk you through the breakdown and the amount you should expect to pay depending on the procedure.


3) Be Vigilant For Surprise Costs

Your doctor might be covered, but don’t assume that anything your doctor orders for you will be covered as well. When she sends you to the lab in the other part of the hospital for a blood test, that service might not be covered under your insurance plan. If anything comes up during a visit, you can always call or chat your Navigator to understand the associated fees and if there are any cheaper options. For instance, it might be significantly less to get a blood test done at a freestanding facility versus at the hospital.


4) Look Into Gap Coverage

If you know that you will need a special service that’s out of network, they can work with you to arrange for that coverage ahead of time. Even if the provider or facility doesn’t normally provide coverage for that service, there may be a way to persuade your insurance company to cover it in the case of a special circumstance. 

Rightway is a healthcare navigation company that is here to make sure that your care is covered. If you ever get a bill you don’t understand, you can send them a photo of it and they will walk you through it. If there are issues, they will contact your providers and insurance to advocate on your behalf and correct any discrepancies in the billing process.

 

 

How to Select Health Insurance

Once a year, your company has an open enrollment period in which you select your health insurance plan for the coming year. This time can be stressful for many people as figuring out how to balance premiums, deductibles, and copays can be tricky.

Professionals can often make the wrong decision about choosing their healthcare plan. Even if you do everything right by researching different plans, confirming that your doctors are in-network, and reviewing prescription limitations; something may still go awry. For example, some plans have a tiered network of providers: tier 1, tier 2, tier 3, etc. In this case, you’d have to make sure that your doctors were in an appropriate tier that matches your budget.

Health insurance can be stressful to understand, and many worry they are not making the right decision on which plan to choose. Here are five tips to help you find the right health insurance plan.

 

 

Make Sure to Read Through All the Changes

Even if you are comfortable with the plan you were on the past year, it is important to consider other possible plans with a better value for your money.

It may be tempting to skip the open enrollment process but know that there may be changes to the plan you were on. Even if your household income hasn’t changed, your plan will likely update automatically. Policies and premiums are not guaranteed to stay the same forever.

The beginning of the year is known to shake things up for consumers, and the insurance industry is no exception. In fact, this year the amount of new insurers entering the market is driving down the cost of premiums in some states; yet another good reason why you should check back in and see what plans are available.

 

Look at the Estimated Yearly Expenses, Not Just Monthly Premiums

When looking at the estimated yearly cost you also have to take the deductible and copayment amounts into account.

The premium is usually put front and center when looking at plans, but there are some online tools to help you calculate the estimated yearly expenses. You can look at HealthCare.gov or certain state marketplaces. The estimated yearly expenses are calculated based on all the different factors, including copays, deductibles, and the amount of healthcare you expect to receive in the upcoming year.

These kinds of tools can be extremely useful when choosing a plan. The math can be tricky to work out with all the different variables involved.

 

alt=“health patient navigator”

 

Determine How Much You Typically Spend on Healthcare

The amount of healthcare you expect to receive can be difficult to determine. The amount will indeed affect the price and is a prime factor in choosing the right health insurance plan near you. While age is a useful thing to consider, you must also account for the possibility of accidents (auto, workplace injury, unexpected diagnosis, etc). Think through all the ways you consume healthcare – from specialists to prescriptions – and which plans best support those use cases.

 

Decide What Your Priorities Are

What it really comes down to:

  • Do you want to pay a slightly higher monthly premium and have a decreased out-of-pocket expense limit?
  • Or do you want to pay a lower monthly premium with higher out-of-pocket expenses? In this case, incidents can be quite costly but there is still the peace of mind of staying insured.

Besides these general considerations, you should also take your specific health needs into account. Are your current prescriptions and favorite doctors covered under the potential plan? Many companies have a search tool for doctors and prescriptions they cover and providers often list what insurance carries they accept.

alt=“family health insurance”

Health Navigators are Available to Help You

Your employer may offer a healthcare navigation platform – such as Rightway. Navigators are clinicians with expertise in healthcare policy to help you with all decisions you need to make around your health and wellness. Not only can Navigators help you find providers and schedule appointments, but they can also explain the plan options to you and help determine which plan is best for your needs.

The main benefit of working with a health navigator is impartial advice. They look for the plan that’s best for you.

Rightway Navigators are available to members through phone or chat in the Rightway app to answer your open enrollment questions. Not sure if you have access to Rightway? Ask your company’s HR director if Rightway is included in your benefits package. 

 

© 2019 Rightway Healthcare. All Rights Reserved.
Download our free mobile app
Download our free mobile app
Google Play
Get it on
employees
App Store
Download on the
icon
healthcare

What is a Healthcare Navigator?

The healthcare system is complicated. We all know it. When making a decision about your care, there is a plethora of resources available, but determining the right ones can be very overwhelming.

For people who have a medical professional in their family, they can count on them to direct them to the best care and to guide them through medical decisions. But who can people who do not have a doctor or nurse in their family turn to for advice? It is this question that Rightway’s dedicated clinical Navigator answers.

 

alt="patient healthcare navigator"

 

Healthcare Navigators are professionals trained to help consumers navigate through the US healthcare system. Their goal is to help you make the best healthcare decisions possible. Whether that means picking the plan that best suits your lifestyle, preparing for a surgery or procedure, or finding top in-network doctors; there’s someone who is trained to help you do just that. A Healthcare Navigator also aids in logistical aspects and helps manage complicated care regimens.

 

Overview

The healthcare system is like a maze, which often leads individuals to several dead ends. A Navigator’s job is to guide you on the right path so that you aren’t led astray by private interests or by profit-motivated individuals.

So let’s dive into more specifics, the different roles that employer and patient healthcare navigators can fulfill, and how they can help you access better healthcare.

 

alt="clinical patient health navigator"

 

But Just What is a Healthcare Navigator Exactly?

They are experts in the health space. The best Navigators have years of clinical experience as doctors or nurses and have help from Health Assistants who have backgrounds in healthcare policy and claims. Their main purpose is to assist members with coordinating care, understanding benefits, and resolving bills. Navigators are required to be unbiased, and their services are free to members as a part of their company’s benefits.

Healthcare Navigators explain how health insurance plans work to their beneficiaries and purchasers. They help them understand their plans and how to find the plans best suited to them.

When it comes to enrollment, there are different ways of applying for health insurance. Two of the standard ways is through paperwork or applying online. Health navigators can help with both, not only with establishing eligibility but also in potentially qualifying you for insurance affordability programs.

Navigators are advocates that mentor you about your benefits, conditions, bills, and all other healthcare needs. If necessary, they can also refer members to additional employee assistance programs.

 

The Clinical Space

Healthcare Navigators also have several duties in the clinical space. These duties include helping members get access to treatment, helping them understand diagnoses and treatment options, as well as analyzing and understanding your healthcare plan so that you don’t have to.

Navigators are concierges that are dedicated to each member. That means every time you call or message your Navigator, you will talk to the same person and they will have files of your preferences and applicable medical information. They are armed with data and analytics to proactively engage you on issues that can improve your health. For instance, they will review blood pressure numbers you convey to them and help you find a Cardiologist if need be.

This has huge implications for patients. When care is given proactively, is patient-centered, and preventive, healthcare providers will be able to spot symptoms in patients earlier as well as provide them with more efficient care. Most major conditions can be prevented through early intervention and patient healthcare navigators are there to make sure all necessary preventive care steps are taken to keep members healthy.

Using Healthcare Navigation Companies For Out-Of-Network Care

If you have engaged with the healthcare system for more than routine checkups, you have probably received a bill you don’t understand. Often, this is because the provider you visited was out of network, the procedure you received was not covered by your insurance plan, or simply the code your doctor entered in your invoice was incorrect. Below are some common instances that can result in an unexpected bill and ways to avoid pitfalls. RightWay Healthcare navigation can help skip the headache.

 

alt="healthcare navigation companies"

Going Out Of network

Going out of network can happen either intentionally or unintentionally. You might be forced under certain circumstances, or you may face unexpected hospital bills from a provider who turned out to be from out of network. 

Circumstances for choosing to go out of network include the following: 

 

Preferred Doctor

Your doctor, who was once in-network decided to opt-out of your network, but this is a doctor that you trust to do the best job. She might be your obstetrician, and there’s no one else you would trust more to deliver your baby. You are willing to pay more out of pocket for this service.


Referral
 

You may get a referral from your surgeon, who is in your network, to go to a radiologist, who is not in your network. After getting your X-rays done, you get a bill from your radiologist that you have to pay out of pocket.

 

Unexpected Costs

The fine print in most can healthcare plans catch people by surprise. For example, in your insurance plan hospital expenses are (seemingly) covered. So you go to the hospital and end up in a private room, which is the only room available at the time. Later on, when the bill arrives, you find out that your insurance company doesn’t actually provide coverage for “private rooms.” You end up having to pay the same amount as you would if you didn’t have any insurance at all. 

So we see the problem with out-of-network services. If you talk to your Healthcare Navigator before seeing a doctor, having a procedure, or visiting the hospital, they will direct you to the best care accessible in your network. Here are some things they can do to ensure you will not get hit with an unexpected bill:


1) Confirm With Your provider

The purpose of contacting your provider is to verify what insurance they accept. While a provider’s website may list common insurance they accept, that may not include your specific insurance plan even if the company is listed. Navigators know the intricacies of each plan, what should be covered, and what questions to ask. They will confirm with the provider that they are covered under your specific insurance policy.


2) Review The Costs With You

Even if a provider is in-network, there are often costs you will still need to cover, such as a co-pay. Healthcare navigation companies can walk you through these costs. They may be simple, such as a $20 flat fee for all specialist visits. But they could be quite complicated such as 20% up to $3,000, 15% from $3,000 – $6,000 and free for anything over that amount. They will walk you through the breakdown and the amount you should expect to pay depending on the procedure.


3) Be Vigilant For Surprise Costs

Your doctor might be covered, but don’t assume that anything your doctor orders for you will be covered as well. When she sends you to the lab in the other part of the hospital for a blood test, that service might not be covered under your insurance plan. If anything comes up during a visit, you can always call or chat your Navigator to understand the associated fees and if there are any cheaper options. For instance, it might be significantly less to get a blood test done at a freestanding facility versus at the hospital.


4) Look Into Gap Coverage

If you know that you will need a special service that’s out of network, they can work with you to arrange for that coverage ahead of time. Even if the provider or facility doesn’t normally provide coverage for that service, there may be a way to persuade your insurance company to cover it in the case of a special circumstance. 

Rightway is a healthcare navigation company that is here to make sure that your care is covered. If you ever get a bill you don’t understand, you can send them a photo of it and they will walk you through it. If there are issues, they will contact your providers and insurance to advocate on your behalf and correct any discrepancies in the billing process.

 

 

How to Select Health Insurance

Once a year, your company has an open enrollment period in which you select your health insurance plan for the coming year. This time can be stressful for many people as figuring out how to balance premiums, deductibles, and copays can be tricky.

Professionals can often make the wrong decision about choosing their healthcare plan. Even if you do everything right by researching different plans, confirming that your doctors are in-network, and reviewing prescription limitations; something may still go awry. For example, some plans have a tiered network of providers: tier 1, tier 2, tier 3, etc. In this case, you’d have to make sure that your doctors were in an appropriate tier that matches your budget.

Health insurance can be stressful to understand, and many worry they are not making the right decision on which plan to choose. Here are five tips to help you find the right health insurance plan.

 

 

Make Sure to Read Through All the Changes

Even if you are comfortable with the plan you were on the past year, it is important to consider other possible plans with a better value for your money.

It may be tempting to skip the open enrollment process but know that there may be changes to the plan you were on. Even if your household income hasn’t changed, your plan will likely update automatically. Policies and premiums are not guaranteed to stay the same forever.

The beginning of the year is known to shake things up for consumers, and the insurance industry is no exception. In fact, this year the amount of new insurers entering the market is driving down the cost of premiums in some states; yet another good reason why you should check back in and see what plans are available.

 

Look at the Estimated Yearly Expenses, Not Just Monthly Premiums

When looking at the estimated yearly cost you also have to take the deductible and copayment amounts into account.

The premium is usually put front and center when looking at plans, but there are some online tools to help you calculate the estimated yearly expenses. You can look at HealthCare.gov or certain state marketplaces. The estimated yearly expenses are calculated based on all the different factors, including copays, deductibles, and the amount of healthcare you expect to receive in the upcoming year.

These kinds of tools can be extremely useful when choosing a plan. The math can be tricky to work out with all the different variables involved.

 

alt=“health patient navigator”

 

Determine How Much You Typically Spend on Healthcare

The amount of healthcare you expect to receive can be difficult to determine. The amount will indeed affect the price and is a prime factor in choosing the right health insurance plan near you. While age is a useful thing to consider, you must also account for the possibility of accidents (auto, workplace injury, unexpected diagnosis, etc). Think through all the ways you consume healthcare – from specialists to prescriptions – and which plans best support those use cases.

 

Decide What Your Priorities Are

What it really comes down to:

  • Do you want to pay a slightly higher monthly premium and have a decreased out-of-pocket expense limit?
  • Or do you want to pay a lower monthly premium with higher out-of-pocket expenses? In this case, incidents can be quite costly but there is still the peace of mind of staying insured.

Besides these general considerations, you should also take your specific health needs into account. Are your current prescriptions and favorite doctors covered under the potential plan? Many companies have a search tool for doctors and prescriptions they cover and providers often list what insurance carries they accept.

alt=“family health insurance”

Health Navigators are Available to Help You

Your employer may offer a healthcare navigation platform – such as Rightway. Navigators are clinicians with expertise in healthcare policy to help you with all decisions you need to make around your health and wellness. Not only can Navigators help you find providers and schedule appointments, but they can also explain the plan options to you and help determine which plan is best for your needs.

The main benefit of working with a health navigator is impartial advice. They look for the plan that’s best for you.

Rightway Navigators are available to members through phone or chat in the Rightway app to answer your open enrollment questions. Not sure if you have access to Rightway? Ask your company’s HR director if Rightway is included in your benefits package.