Getting The Most From Your Individual Health Plan In Texas

By: Pat Carpenter

How can you effectively utilize your individual health insurance plan? It starts by becoming an active participant in your own health and healthcare. Remember - the best offense is a great defense. In other words, learn the importance of preventive care while you're young and healthy.

Health Screenings.
Hospitals, clinics and community groups in Dallas, Houston and throughout Texas often hold health screenings. Sometimes for free, more often for a nominal fee. Find out about health screenings in your area and be sure to get them.

Eat Well.
A healthy, balanced diet can help you avoid a multitude of health problems, including obesity, heart disease and adult-onset diabetes. It also helps with many pre-existing conditions, like high blood pressure and depression. And on top of all that, it'll make you feel pretty darn good.

Begin an Exercise Program Today!
Studies show that even moderate exercise three times per week can offset an adult's risk for heart attack, stroke and certain cancers. So don't wait. Stop the excuses and just get out there and do it.

Ask questions. Listen for answers.
Talk to your doctor and, if you have any concerns, let him/her know immediately. In addition, know what prescriptions you're taking, when to take them and what not to mix with them. Ask about the risks and benefits of each test and treatment you undergo. Make sure you understand your doctor's answers. Feel free to take notes, especially if things sound confusing.

When in doubt, put it down on paper.
Speaking of taking notes, remember to keep a log or diary of symptoms, concerns or unusual problems that may occur. That way, when you go in to see a doctor, you'll have a clear record. Also, make sure to keep a folder with a record of treatments, vaccinations, lab tests, drug reactions and side effects.

Know your Health Insurance Plan
Even though it's not a whole lot of fun, you should definitely read and reread your health insurance policy - particularly the information on benefits, coverage, exclusions and limits. If your plan sends you a newsletter or magazine, read that as well. Stay on top of policy changes and new services that may affect your overall care.

Knowing how to obtain care.
Don't wait until you're nearly on the floor writhing in pain to learn coverage specifics like urgent-care hours and how to schedule appointments. Do it while you're feeling good. Don't forget to find out how, and where, to get lab tests, as well as what number to call in an emergency.

If Something Goes Wrong!
If you have a bad experience with your Health Maintenance Organization (HMO) managed health care provider, you have the right to complain. Contact the member services division of your plan immediately for more information on how to register a complaint. All health insurance plans (Preferred Provider Organizations, or PPOs, as well as HMOs) have grievance or appeals processes. During the complaint process, make sure to save records of all correspondence, claim forms and copies of bills. Also keep a log of phone conversations and names of the people you've spoken to.

If this process doesn't solve your problem, you might consider bringing the matter to the Texas insurance commissioner or department of health. Medicare or Medicaid recipients may file a grievance with the state's Medicaid program as well as the Texas medical peer review organization.

Know Your Rights.
If you are in an HMO plan, you have the right to: change your primary care doctor, switch plans during open enrollment (if you are in a group plan at work), ask for copies of your test results and medical records, refuse treatment, disagree with your plan's decisions and use their appeals process.

Remember - it's your health - take charge of it and life will be that much better because of your participation.

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