Discover - Blog , Employee Benefits

Leveraging In-Network Providers for Enhanced Healthcare Savings and More

Sat, 01 Jun 2024 14:24:00 -0500

Last Updated: March 20, 2026

Choosing a healthcare provider is an important decision that deserves careful thought.

There are many factors to consider, but one of the most important is whether the provider is part of your insurance plan's network. Getting general care, specialized treatment, or urgent care from in-network providers can offer you significant benefits.

Here's why...

The biggest advantage of staying within your insurance network is the potential for substantial cost savings. When you choose doctors and hospitals that are part of your insurance plan's network, your deductible and coinsurance costs tend to be much lower. This happens because your insurance company and in-network providers have already agreed on negotiated rates.

This arrangment protects you from unexpected medical bills or balance billing, giving you greater financial stability as you manage your healthcare.

On the other hand, if you use providers outside your network, balance billing can become a costly burden. Out-of-network providers can charge you the difference between their "retail price" and what your insurance company will cover. Since there is no rate agreement, these providers are free to charge more, often leaving you with a hefty out-of-pocket bill. Sticking to in-network care helps you avoid this risk.

Another key benefit of in-network care is the smoother coordination between your provider and your insurance company. Because they work together regularly, in-network providers can help speed up claim processing, ensure accurate billing, and protect you from being overcharged. This teamwork benefits both parties, giving you peace of mind that your healthcare transactions are handled correctly and efficiently.

Insurance plans also often require authorization for certain medications or treatments. In-network providers are usually more familiar with these requirements and prepared to handle the necessary paperwork promptly. This can speed up approvals and prevent delays in your treatment.

In summary: Choosing in-network healthcare providers is a smart move. It can save you money, simplify claims, and make your overall healthcare experience smoother and less stressful.

Before selecting a healthcare provider or facility, take a moment to verify with your insurance company whether they're in-network. This simple step is a proactive way to protect your wallet and ensure your health journey goes as smoothly as possible.

Click here for other blogs related to healthcare navigation

Making the Most of Your Employee Benefits

Mon, 16 May 2022 15:19:22 -0500

You have great employee benefits! Make sure you are using them to their fullest potential.

1. Secure your Insurance ID Card and make sure you are paying your monthly premiums

When you completed your open enrollment, your insurance company should have sent you (and your dependents) a new healthcare ID card in the mail. This card is your key to reaping the benefits of having health insurance when you visit your doctor for care. You likely opted to pay for your monthly insurance premium (which pays for your health insurance) on a monthly or bi-weekly basis through payroll deductions.

2. Healthcare Advocacy

Know who to contact with your questions. Ensure upcoming services you may need are covered, and help yourself prepare for what your costs will be. If your company works with a Benefits Broker, there may be a healthcare advocacy program available to you as an employee to help you understand and navigate your benefits. Ask your HR team about healthcare advocacy.

3. In-Network Provider Contracts

One of the benefits of working with an insurance provider is the added financial security of their network. Insurance providers negotiate rates with health care providers to provide services to their clients at a lower rate than their typical “retail value”. Select a health care provider in your network who you are comfortable with and who you feel meets your unique health needs. Talk to your healthcare provider about recommended health screenings that may be covered under your insurance. Remember, you will likely pay more if you choose to see a provider who is out-of-network. Read more on choosing a primary care provider >

4. Telehealth

Telehealth saves you not only time, but also money. Talk with your health care provider about their telehealth offerings. Telehealth is convenient, affordable and effective for most common ailments you would normally schedule an appointment and make the trip to your doctor’s office for. Learn more about telehealth.

5. Employee Assistance Programs (EAPs)

employee assistance programs offer resources for ALL employees to achieve a healthier work/life balance. Typically offered at no cost to employees as a perk included in company-sponsored benefit plans, EAPs’ completely confidential expert services could cover; financial stressors, legal problems, marital struggles, adoption assistance, sleep disturbance, retirement planning, virtual doctor visits (telehealth), depression, anxiety, workplace performance issues, trauma recovery, life coaching, and much more. Today, nearly all employee assistance programs offer telephonic or video-based counseling sessions.

6. Health Savings Accounts (HSAs)

A Health Savings Account, or HSA, is a savings account where you can deposit money on a pre-tax basis to pay for qualified medical expenses. The list of qualified Medical Expenses is huge, and you may be surprised by what you can pay for using money from your HSA. While anyone can open a health savings account, you may only contribute money to your HSA if your Medical Plan is a High-deductible health plan or an HSA qualified plan.

7. Get your free stuff

A number of preventive care measures are covered at 100% under your insurance plan.

· Your annual well visit

· Blood pressure screenings

· Cholesterol screenings

· Depression screenings

· Hepatitis B & C Screenings

· Immunizations

These preventive care measures are your best bet to ensure you are healthy, and stay healthy.

8. Shop around for and fill your prescriptions

Your insurance can be a big player in cutting the cost of your medications. Get them filled, and be sure your prescriptions have prior-authorization if necessary to receive the help your insurance company provides in paying for your medication. Ask in advance how much your prescription costs and if there is a more affordable option. There may be more affordable options outside of insurance assistance such as GoodRx, Amazon Pharmacy or the Walmart $4 drug list.

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Understanding Your Healthcare Coverage

While having health insurance is important for when you are sick and needing treatment, it is also an important player that assists with financing care that maintains your health.

Understanding Healthcare Coverage

Tue, 10 May 2022 16:24:44 -0500

While having health insurance is important for when you are sick and needing treatment, it is also an important player that assists with financing care that maintains your health.

As a benefits plan member, your coverage likely includes many free services such as immunizations for children and adults, annual well visits, obesity screening and counseling for all ages, and more.

Healthcare plans differ in many ways. The most notable difference is in deductible and out-of-pocket maximum amounts. An important part of understanding your healthcare coverage is understanding the terms and acronyms, such as deductible and out-of-pocket maximum, commonly used in healthcare.

Here is a list > of 10 common health insurance terms that you, as a healthcare consumer, should know.

Once you have chosen a plan that best meets yours/your family’s needs, ask your insurance provider for a Summary of Benefits and Coverage document which will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

What Will My Care Cost?

Here are some questions you can ask your insurance company to help you better understand your coverage and what you will pay when you get health care.

• How much will I pay for a primary care visit? A specialty care visit? A mental/behavioral health visit?

• Would I have to pay a different amount if I see an “in-network” or “out-of-network” provider?

• How much do I have to pay for my prescription medicine, and is there a generic version available?

• Are there limits on the number of visits I can schedule with a provider, like a behavioral health provider or physical therapist?

• How much will it cost me to go to the Emergency Room if it’s not an emergency?

• What is my deductible?

• Do I need a referral to see a specialist?

• What services are not covered by my plan?

• Does my visit require prior authorization? If so, is there a list of procedures that require the prior authorization?

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Health Insurance ID Card

Thu, 28 Apr 2022 10:54:55 -0500

Updated: 4.8.25

After selecting your healthcare plan, your insurance company should send you a packet of educational materials that summarize your plan coverage and plan specifics. This information is important for you, as a healthcare consumer, to digest and keep in a safe place for future reference. If you do not understand these documents, call your insurance provider with your questions. If your company has secured a free healthcare advocacy line, such as through your benefits broker, this is also a great option to get your questions answered.

Your health insurance ID card is an important piece of this packet from your provider. Your Health Insurance ID Card is proof of your insurance. If you did not receive this card, call your provider to request a one.

Most health insurance ID cards include the following information:

1. Member. This is usually printed on the front of your card and includes your name and sometimes a dependent as well.

2. Member ID. This number identifies you and tells your provider how to bill your health plan. If your spouse or children are also on your coverage, your member numbers may look very similar.

3. Group Number. This number is also used to identify you and tell your provider how to bill you, as well as track the specific benefits of your plan.

4. Deductibles: These amounts reflect the health costs you are responsible for before the health plan starts sharing costs in both in-network and out-of-network situations.

5. Out of Pocket (OOP) Maximums: The out-of-pocket max is the most you will pay in a given year for all covered services. This is a combined total of deductible, coinsurance and copayments made for any one individual. Once the out-of-pocket max has been met, all covered services are covered with no additional cost share.

6. Phone numbers. Questions about finding a provider, what your coverage includes, how much you will pay for a service or how to navigate billing and payments? A member services number will be listed on your card for you to call for help.

Additional Health Insurance Terminology

Participating Provider: A care provider (Doctor, Geriatrician, Internist, Nurse Practitioner, Physician Assistant, Gynecologist, or Pediatrician) who is a part of your health insurance plan’s network of providers and have a negotiated discount on select services, which will save you money!

Healthcare Advocate: A Healthcare Expert who (in compliance with HIPPA) assists you in navigating your healthcare needs whether it be problems with a claim, billing discrepancies, understanding your explanation of benefits, or any other questions you have regarding your healthcare.

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Preparing For Your Well Visit

Your annual well visit (also referred to as an annual physical, checkup, or exam) is covered at 100% by your health insurance provider. Seeing your doctor each year is a crucial piece of an effective preventive care routine.

Telehealth

Tue, 11 Jan 2022 15:18:24 -0600

Telehealth (noun; the provision of healthcare remotely by means of telecommunications technology) now allows consumers to receive healthcare from wherever they are: the comfort of a Livingroom, at the office, or while traveling away from home. Seeing your provider in person can be difficult when you have transportation issues, a lack of mobility, a busy schedule or are traveling. With telehealth (or telemedicine), you can use your smartphone, desktop computer, laptop, tablet or other technology with video capabilities to connect with your care provider. Through your device, you can chat with your provider as well as send and receive messages.

As an added bonus, telehealth is often a fraction of the cost when compared to an in-person visit with your doctor.

The Benefits of Telehealth

Quickly increasing in popularity, virtual healthcare saves patients not only time, but also money. The emergence of telehealth was primarily to make healthcare accessible to people who live in rural or isolated communities, or have limited mobility, time or transportation options. That being said, telehealth is equally beneficial for today's working individual with a busy schedule. Have you ever found yourself in need of a quick doctor consultation without the time to drive in to a facility and wait for one?

The estimated cost of a telehealth or virtual doctor visit is $59 or less. Pick up your phone, tablet, or laptop and schedule a virtual, face-to-face chat with a Board-Certified Doctor when faced with coughing, eye or ear pain, a fever, headache, nausea, sore throat or similar mild symptoms. Typically, your desired telehealth service will require the creation of an online account with the service provider, or calling of a toll-free number.

Types of Telehealth Care

Any virtual offering of healthcare services is considered telehealth and you can receive many types of care this way. Most telehealth services are available under most health plans. Check with your healthcare provider to see what services you may be able to access from home. You may be able to get:

• Wellness visits and other preventive care

• Prescriptions for medication

• Dermatology (skincare)

• Nutrition counseling

• Urgent care (limited) for common concerns including a sinus infection, back pain, urinary tract infections or rashes

• Remote monitoring services (where you might use a device that sends information to your provider about your vital signs, for example)

• Behavioral Health Care such as mental health counseling, follow-up care plans, or services for substance use disorders, including opioid use disorder

How to schedule a telehealth appointment

If you have a primary care provider, call their office. Many providers now offer telehealth, even if they didn’t before. If you are looking for a new primary care provider, always call and ask if the provider you are interested in seeing is taking new patients. Ask your provider:

• Do you offer telehealth visits?

• Is telehealth a good choice for my specific visit needs?

• How do I schedule my telehealth appointment?

• What technology will I need, and should I download an app or software?

• If you’re concerned about privacy, ask how your personal information will be protected.

Prepare for your telehealth appointment

• Make sure you have access to a phone or video capable device with internet

• Find a quiet, private place where you are comfortable

• Take a video or photo of anything you’d like to show the provider. Send the images ahead of your appointment

• Have information ready about your allergies, medications, hospitalizations, surgeries, and test results. • Write down any questions you have

• Prepare to take notes

• Be ready to show the devices or tools that help you monitor your chronic conditions, if you use any. For example, have your blood pressure monitor nearby

What to expect during your telehealth visit

• For a scheduled visit, your provider will give you instructions about how to access their system

• For an unscheduled visit, you’ll usually connect to a provider through a website

• The provider should ask if you agree or “consent” to services by telehealth

• You’ll talk with a provider. This will be similar to discussions during an office visit

• Let your provider know if you have trouble hearing or seeing them. If there are technical problems, they may be able to continue just by phone

• At the end, the provider will let you know their recommendations. They may share more information by email or mail. They will let you know how to contact them if you have questions or concerns

Reaping the benefits of telehealth services is easy and cost-effective. Inquire with your Human Resources department to find out what virtual health services are available to you through your company benefits plan.

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Employee Assistance Programs (EAPs)

Mon, 25 Oct 2021 14:06:01 -0500

Employee assistance programs, or EAPs, have evolved since their inception just under a century ago. So much so, that what we know as today’s broad EAP scope stemmed from a single program. The original Alcoholics Anonymous (AA) was created to treat the negative effects alcoholism had on overall job performance. In the last 80+ years, EAPs have grown to encompass a multitude of services which tackle struggles faced both in the office and at home. EAPs aim to treat the effects these struggles have on employee well-being, productivity, and overall happiness.

The stigma that employee assistance programs are only for individuals who suffer from substance abuse or mental health struggles is simply not true. The progression of EAP development encompasses needs for all walks of life. Typically offered at no cost to employees as a perk included in company-sponsored benefit plans, EAPs’ completely confidential expert services could cover; financial stressors, legal problems, marital struggles, adoption assistance, sleep disturbance, retirement planning, virtual doctor visits (telehealth), depression, anxiety, workplace performance issues, trauma recovery, life coaching, and much more. Today, nearly all employee assistance programs offer telephonic or video-based counseling sessions.

The Benefits of Employee Assistance Programs Extend Beyond the Employee

EAPs are a substantial perk for employees. Furthermore, the eligibility of these programs extends beyond the employee to their spouse and dependent(s). Telehealth services have allowed for children to receive counseling via a smartphone, tablet, or laptop from the comfort of their own home. With the extension of these benefits to spouses and dependents, the whole family can better tackle life’s obstacles and increase individual and family well-being.

Why Should Employees Consider Using EAPs?

According to a recent SHRM employee benefits research pole, 79% of surveyed employers offer some form of employee assistance program(s). As the scope of EAPs has progressed and utilization has increased, some studies suggest that an increase in utilization has resulted in lower medical costs, less absenteeism, and an increase in employee productivity.

Begin Your Search For Employee Assistance Programs.

Fortunately, there are many employee assistance programs available, ranging from free community resources to employer-sponsored plans and programs offered as part of an insurance benefit. Speak to your HR Department or Benefits Broker to get aligned with the EAP resource(s) available to you and those around you.

What is a Health Savings Account

Wed, 20 Oct 2021 12:46:22 -0500

What is a Health Savings Account?

Can anyone open a Health Savings Account?

Yes, but you may only contribute money to your HSA if your Medical Plan is a High-deductible health plan or an HSA qualified plan.

Can I deposit $10,000 dollars a year in my Health Savings Account?

That would be nice to have $10k to put in your HSA this year, however the IRS sets up yearly limits and it typically changes from year to year.

Where can I open a Health Savings Account?

Most banks or credit unions offer HSA Accounts and are typically very easy to open. Some employers require you to use a bank of their choosing, so be sure to pay close attention to this information at open enrollment, and ask your Human Resources department if your organization's preferred HSA host is not clarified.

Who can deposit money into your Health Savings Account?

This could be your mother, your brother, your aunt … the list goes on. Some employers can directly deposit pre-tax money into your Account. This is typically done every pay period. Oh, you can also deposit your own money!

Can I deposit money from my checking/savings account directly into my Health Savings Account?

You most certainly can. You can move money from your checking or savings account into your HSA but be mindful of these 2 important details:

1. The money you just added from your checking/savings account was not pre-taxed

2. You still must adhere to the yearly limits set by the IRS (see chart above).

How do I get tax credit on the money I deposited post-tax?

So, you moved money from your checking/savings account into your HSA to pay a medical bill or purchase products on the qualified list of medical expenses. Smart move! Keep track of how much money you deposit and when you deposited it. When it’s time to do your taxes, you can account for that money. Best to consult your accountant or tax consultant.

Does your Health Savings Account ever expire?

Heck no! That’s the beauty of it. You don’t start at $0 at the beginning of every year. Your Health Savings Account is not your employer's account, it’s your account. However, if you no longer have a qualified high-deductible health plan (HDHP) or HSA qualified plan, you can no longer deposit into that account. Let’s say you or your company has an HDHP plan one year, but a standard co-pay plan the following year. You don’t lose that money; you can still use it to pay for those qualified Medical Expenses, but you just can’t deposit money in that account.

Seriously, I can use my HSA money on that?

One great thing about Health Savings Accounts is that the list of qualified medical expenses is vast. You’ll even see pharmacies and online retailers indicating that a product is HSA qualified. In addition to paying for your medication, doctor co-pays, etc…. there are some surprising everyday and not-so-everyday items you can use your HSA to pay for:

· Acupuncture

· LASIK

· Cold Medicine

· Chiropractor Visits

· Pain Relievers

· Sinus Medication

Let’s wrap it up!

These are just a few highlights of Health Savings Accounts, but there is more to learn! Don’t be afraid to ask questions. Call your broker or call your insurance carrier. Most insurance carriers will have brochures or online material and links to Health Savings Account materials.