BCDI’s Medical Social Worker can help you with your insurance or billing questions. If your insurance policy is changing and you have questions about how it will affect your coverage, please call (309) 692-5337 or send us an email.

Navigating through the Health Insurance Marketplace

It doesn’t matter what type of insurance you end up with, you need to know what it covers and the costs before you buy it. Make sure you ask the following questions:

  • Are my medications, including those to treat my bleeding disorder, covered?
  • Are my providers (including my HTC) in network?
  • Do I need a referral to see a specialist?
  • What services require prior authorization?
  • What will my total cost be (premiums, maximum out of pocket, deductible)?
  • What services are covered (PT, labs, genetic testing, etc.)?
  • Does the plan use an accumulator adjuster or copay maximizer?

Before purchasing a plan carefully evaluate the following:

  • Benefit Summary – Health insurance and group health plans are required to provide you with an easy to understand summary of a health plan’s benefits and coverage
  • Drug Formulary – Health insurers maintain a formulary (sometimes referred to as a Preferred Drug List). This is a list of prescription drugs covered through a health plan. Formularies classify drugs by different cost tiers that define the plan member’s copay amount
  • Provider Network Booklet – A provider network is a group of healthcare providers that have contracted with the health plan to provide services to plan members at agreed upon billing rates. Depending on the plan’s design, members who receive care from a provider not included in the network may have less or no coverage for that provider/service received. Review the provider network for each plan you consider to ensure it has the doctors and services you need
  • Accumulator Adjuster and Copay Maximizer – When a copay card is used, the portion the manufacturer pays to the insurer does not get applied to the deductible or out of pocket expenses

Patients seeking assistance in learning more about a particular insurance plan, both in the Marketplace and outside of the Marketplace should:

  • Review the Benefit Summary of the insurance plan (Google the name of the plan to get to their website, and contact the insurance provider)
  • Contact a Navigator or Marketplace assistance regarding the plan http://getcoveredillinois.gov
  • Contact the insurance provider (Google the name of the plan for contact information)
  • MOST IMPORTANTLY, be sure to write down the date, the name of the insurance representative and telephone number of whom you spoke to regarding the insurance coverage
  • Be aware of deadlines for submitting documents, mailings, payments and adhere to them

For further information and assistance, visit healthcare.gov or call (800) 318-2596 (available 24 hours, 7 days a week).

For the State of Illinois visit getcoveredillinois.gov or call (866) 311-1119 (8am- 8pm, central time).