Navigating the System / Urgent or Emergency Care
Yes. If you need emergency dental care and go to the Emergency Room (ER), the ER will treat you and then bill your health insurance. The ER is not likely to be able to treat a dental problem unless it is a health emergency. They may use temporary measures to relieve pain until you are able to see a dentist. Your coverage will depend on your health plan. You can either check your plan documents or website or call your insurance customer service to verify coverage.
Planning ahead
The best plan…
Navigating the System / Urgent or Emergency Care
If it’s an emergency, call 911 or go to the emergency room right away!
Emergency rooms are open 24 hours a day for injuries or illnesses that pose a threat to someone’s life or long-term health. If you have a medical emergency, go to the closest hospital — you’ll be treated whether you have health insurance or not.
If you go to an emergency room, you may not have a choice about what doctor provides care. Even if you have health insurance and go to an in-network emergency room, you may receive…
Navigating the System / Provider networks and referrals
A referral is like getting a prescription from your regular doctor to go see a specialist. Referrals have expiration dates. Some have a limit on the number of visits. So, if you need to see the specialist after the end date on the referral or for more visits, you will need to get another referral.
You could pay a lot more
If your plan requires a referral but you don’t get one, you could pay a lot more. For example, your plan may charge you a penalty, cover the visit at a lower level, or not…
Navigating the System / Provider networks and referrals
Often, when doctors are out sick, their office staff calls to notify patients and reschedule appointments. Sometimes, instead of rescheduling appointments, a doctor may refer patients to another doctor.
If you plan to see a doctor that is covering for your primary care provider, it is your responsibility to confirm that the covering doctor is in-network before you receive care. Learn more about provider networks.
Failure to confirm that you are seeing an in-network doctor can result in…
Managing your Cost / Understanding Your Costs
A premium is the amount you pay for health insurance every month. Just like your car or home insurance, it’s the amount you pay to the insurance company so that you’re covered―whether you use it or not.
If you receive healthcare coverage through your work, your employer may pay a percentage of your premium, with the rest being deducted from your paycheck (you can review your pay stub or contact your employer for more information).
Premiums can vary quite a bit depending on the…
Navigating the System / Getting care, what's covered
Alternative health care services are health treatments that are not typically provided in a traditional Western medicine practice. There are a wide range in practices, but typically these services focus on creating health through balance between mind, body, spirit, and environment. Research can help you understand the pros and cons of alternative care options.
There are different categories of alternative health services.
“Complementary” treatments are used with standard medical…
Navigating the System / Provider networks and referrals
Provider networks are made up of doctors, other healthcare providers, pharmacies, and facilities who contract with insurance companies to become an "in-network” provider. If you go to a provider who is in your insurance company's network, you will typically pay less than if you go to an “out-of-network” provider who doesn't have a contract with your insurance company.
Insurance companies have different networks of healthcare providers for different health plans, so it’s important to check if a…
Navigating the System / Urgent or Emergency Care
An urgent care center is a walk-in clinic that focuses on caring for patients who need care right away but are not having a life-threatening emergency. If it’s an emergency, call 911 or go to the emergency room right away!
Generally, you don’t need a referral, just be sure to go to an in-network urgent care center.
If your problem is less serious, you may be better off going to urgent care center. You may get care more quickly and less expensively than you would in the emergency room.
Why go…
Navigating the System / Getting care, what's covered
Keep in mind, health plans only cover what they consider “medically necessary.” For example, plastic surgery would not be covered just because you want to improve the way you look. But, it would likely be covered to fix a problem (even if afterwards you like your nose better).
Major medical type commercial health insurance is linked to covering health care…
Getting Health Insurance / Getting health insurance coverage
How do I sign up for insurance in NH? Should I shop around for health insurance? Who can help me with buying health insurance? Information you need to know during open enrollment in New Hampshire is right here.
Navigating the System / Getting care, what's covered
Health insurance is not always easy to understand. Take some time to find out what your insurance will pay for and learn how to use your coverage.
Be on time with your premium payments
If you bought health insurance yourself, you should get the first bill from your insurance company within 10 days of signing up. You could lose your coverage if you don’t pay your premium on time every month. If you don’t receive a bill, call customer service and ask about it.
If you have health insurance…
Getting Health Insurance / Your options and why you need coverage
Consumers in New Hampshire have many options for health insurance. The insurance companies with the largest presence in the state are:
Aetna: https://www.aetna.com/
**Ambetter: https://www.ambetterhealth.com
**Anthem Blue Cross and Blue Shield: https://www.anthem.com/
Cigna: https://www.cigna.com/
**Harvard Pilgrim HealthCare: https://www.harvardpilgrim.org
Tufts Health Freedom Plan: https://tuftshealthplan.com/
United HealthCare: http://www.uhc.com
**…
Getting Health Insurance / When things change
Major life changes, known as qualifying life events, can allow you a special enrollment period to change your health plan outside of the standard open enrollment period or policy renewal date. If you have a qualifying life event, review your health insurance coverage to see if you, your spouse, or your dependent children need to make any changes.
The following are examples of qualifying life events:
Getting married or divorced
Having a baby
Adopting a child or placing a child for…
Managing your Cost / Understanding Your Costs
Balance billing occurs when your out-of-network healthcare provider bills you for the difference between their charges for the service you received and the amount your insurance plan has established as the allowed amount. If your health insurance coverage does not include out of network services, you will be billed for the entire provider charge.
Example
Your doctor charges $6,000 for a surgical procedure. Based on the negotiated contract between your insurance company and the…
Managing your Cost / Don't Overpay!
There are several types of accounts available to help you save on your taxes and manage your medical costs.
Health Savings Account (HSA)
You don’t need to have health coverage through an employer to set up and contribute to an HSA, but you do need to be enrolled in a high deductible health plan that meets Internal Revenue Service (IRS) requirements. For calendar year 2024 the annual limitation for deductible for an individual is $4,150 and for a family is $8,300.. There are other…
Navigating the System / Provider networks and referrals
What are narrow network plans?
A narrow network plan refers to a health insurance plan with a smaller than usual, or “narrow,” provider network. In a narrow network plan, health insurance companies try to lower costs by working with a smaller number of providers and fewer in-network facilities. Narrow network plans are offered by employers, through the Health Insurance Marketplace (www.HealthCare.gov), and in Medicare and Medicaid plans.
Why might you choose a narrow network?
The main…
Getting Health Insurance / Getting health insurance coverage
Before you buy a health insurance policy, make sure you understand what you are buying. Click here to find information about what health insurance covers, what costs are included in health plans and helpful tips for managing the cost of your health care.
Managing your Cost / Can't Afford Care
There are a number of ways to make your prescriptions more affordable, depending on your situation and the medications you need.
Money-saving ideas
Ask your doctor or pharmacist if a generic version is available. Generic drugs are typically less expensive than brand-name drugs. Learn more.
Consider getting your prescriptions through a mail-order pharmacy. Learn more.
Look for coupons on the internet by searching for the drug name and financial assistance. You may find coupons on the…
Managing your Cost / Don't Overpay!
Billing mistakes can happen. If the amount on your Explanation of Benefits (EOB) doesn't match the bill from your healthcare provider, take the following steps :
Collect all of the paperwork. Sometimes more than one EOB applies to a single bill.
Compare the codes/descriptions of services from your EOB and your medical bill and make sure that they match and look for duplicate charges.
Review the services to make sure that only services that you received are listed, and that the amount you…
Managing your Cost / Don't Overpay!
If your claim is denied, start with a few basic questions:
Was your insurance coverage in effect at the time of the service?
Was the healthcare service a covered benefit? Was it medically necessary? Learn more.
Was the care provided by an in-network provider?
Were all necessary referrals or preauthorization from your insurance company in place? Learn more.
If you think the services should have been paid, you may want to ask your insurance plan to reconsider. If that doesn’t work, your…