15 Insurance Tips: Dos and Don'ts

1. Before you schedule an appointment, confirm your doctor or hospital is a network (PPO) provider.  To find a provider near you, visit the Blue Cross Blue Shield of Texas website:  www.bcbstx.com/ut or contact UT Select customer service:  1-866-882-2034.
2. Always present your ID card at the time of your appointment.  Don’t assume your doctor’s office has secured or maintained an updated copy of your identification card.  Please note:  A new ID card will be mailed by Blue Cross Blue Shield of Texas to your home address in August 2009.
3. Never pay more than your co-pay at the time of your office visit.  Your doctor should file a claim with the insurance company.  You will then receive a statement from the insurance company that explains what charges were filed, what the insurance company paid, and what you owe the provider.
4. Avoid seeing doctors outside of the network.  If you go to a provider outside of the network, the benefit you receive will be reduced.  However, if a situation is life or limb threatening, you may go to an emergency room that is not part of the network and still receive network benefits.
5. Obtain pre-authorization (at least 24 hours in advance) for any hospital admission other than an emergency.  If your admission is related to an emergency situation, you must obtain preauthorization within two working days after admission or as soon as reasonably possible thereafter to avoid a reduction or denial of benefits.
6. Don’t ignore your bills.  Review bills from your healthcare providers carefully.  If the insurance company has not paid your provider, 1st contact your provider to confirm a claim has been filed, 2nd visit the Blue Cross Blue Shield of Texas website or contact UT Select customer service to check the status of your claim, 3rd contact the benefits office for additional assistance.
7. Visit a dentist in the network.  Discounted rates have been negotiated between Delta Dental and network dentists.  These are typically lower than the rates charged by dentist not participating in the network.  You pay only your portion of the bill at the time of service.  The dental office should complete and submit a claim to the insurance company for you.
8. Visits with a non-contracting dentist are allowed.  If you wish to visit a dentist that is not participating in the network, you must pay for the visit at the time of service and file a claim with the insurance company to get reimbursed.  The plan will pay only an amount up to the allowed fee applied when using a contracting dentist.
9. Take advantage of your dental benefits if enrolled.  Preventive services, i.e. two cleanings per year, are covered at 100%.
10. Ask your doctor if a generic drug can be prescribed for your condition.  Co-pay is only $10 at the retail pharmacy and $20 at the mail service (home delivery) pharmacy.
11. Don’t take a brand name drug, if a generic drug is available.  For brand name drugs with a generic alternative, members must pay the difference between the cost of the brand name and the generic drug plus the generic drug co-payment.
12. Use the mail service pharmacy if you are taking medication for a condition on an ongoing basis.  The mail service pharmacy allows you to obtain up to a 90-day supply per prescription, plus three refills.  The service is a cost and time saving benefit.  For more information, contact the benefits office.
13. If you are enrolled in the vision plan, you must go to a provider that is in the network unless you receive prior approval from the insurance company to go elsewhere.  If you go to a non-network provider, the benefit you receive will be less.
14. Take advantage of your vision plan benefits if enrolled.  Your eye exam (after a $35 deductible) and one pair of eyeglasses are covered at 100% per plan year.
15. Review your check stub.  Verify the appropriate insurance premiums are being withheld from your paycheck.

Revised: July 1, 2009