HOW HEALTH INSURANCE WORKS
I have insurance, now what?
Once you have insurance, you should focus on getting a primary care doctor. Preventive services include health care like screenings, checkups, and patient counseling that are used to prevent illnesses, disease, and other health problems or to detect illness at an early stage when treatment is likely to work best. Getting recommended preventive services and making healthy lifestyle choices are key steps to good health and well-being.
Why should I get preventative healthcare versus emergency services?
Having a provider who knows your health needs and whom you trust and can work with, can help you:
- Ensure you get the preventive services that are right for you
- Make healthy lifestyle choices
- Improve your mental and emotional well-being
- Reach your health and wellness goals.
What/who is a provider?
A primary care provider is who you’ll see first for most health problems. He or she will also work with you to get your recommended screenings, keep your health records, help you manage chronic conditions, and link you to other types of providers if you need them. If you’re an adult, your primary care provider may be called a family physician or doctor, internist, general practitioner, nurse practitioner, or physician assistant. Your child or teenager’s provider may be called a pediatrician. If you’re elderly, your provider may be called a geriatrician.
Where can I find a doctor?
- Depending on your coverage and personal circumstances, you might find a primary care provider in:
- Private medical groups and practices
- Ambulatory care centers and outpatient clinics
- Federally Qualified Health Centers
- Community clinics and free clinics
- School-based health centers
- Indian Health Service, Tribal, and Urban Indian Health Program facilities
- Veterans Affairs medical centers and outpatient clinics.
How do I prepare for an appointment?
When you make your appointment, have your insurance card or other documentation handy and know what you want.
Here are some things you should mention when you call and what you might be asked for:
- Your name and if you’re a new patient.
- Why you want to see the provider. You might want to tell them you are looking to find a new primary care provider and ask for a “yearly exam,” or a “wellness visit,” or you might ask to come in because you have a specific concern, like the flu, allergies, or depression.
- The name of your insurance provider and plan or that you have Medicaid or CHIP coverage ready. Make sure you have the correct information about which providers in the office are in your network.
- The name of the provider you’d like to see. You may have to wait longer for an appointment if you request a specific provider, so they might recommend another provider in your network if you’re feeling sick and need to come in sooner.
- If you have a specific need—like translation or accessible medical equipment—ask whether the provider and the office can meet that need. If they cannot, ask if there’s another provider in the office who can.
- The days and times that work for you. Some offices have weekend or evening appointments.
You should also ask:
- If they can send you any forms you need to fill out before you arrive. This will save you time on the day of your visit.
- If you need to bring anything to the visit, like medical records or current medications.
- What to do if you need to change or cancel your appointment. Some offices charge a fee for missed appointments, late appointments, or appointments canceled less than 24 hours before they start.
Health insurance terms
Explanation of Benefits (or EOB)