The Portal

This week I’m going to do a PSA about the patient portal or the client policyholder portal.

All insurance companies have an online portal.

If you have existing coverage and have you not set up your portal, need to set it up your portal, ASAP.

Anytime you get new coverage, you need to set up your portal ASAP. Why do you need to set up your portal? Well, first of all, I am not available 24/7, and your portal is. And a lot of great information is in your there.

First off, there are your ID cards. In the portal, you have access to your ID cards 24/7. You can download them to your phone. Some companies even have an app that you can keep on your phone that allows you to have access to your cards in case you go somewhere, and you don’t have to worry about having your physical ID card- you still have access to the information.

The second benefit of setting up your portal is for the provider search. Your portal has a provider search that is specific to your plan. I can’t tell you how many times I see people on all these swap groups asking for a recommendation from a good doctor who takes Blue Cross Blue Shield. The problem with this is that Blue Cross Blue Shield has hundreds, if not thousands of plans. How do you know which plan this doctor takes? I can tell you doctors do not take all the plans that are offered by any carrier. That’s important to note. If you want to make sure you get a doctor that’s in-network, use your provider search in your portal.

Thirdly, you can also search for medications to see what’s covered is, and what’s not covered. A lot of plans have different tiers, which relate to how much generics cost and how much brand names cost. Using your portal to find out pricing can help you find out if you should use something like GoodRX – which sometimes gives you a better price than your copay does for your insurance. Do what’s cheapest, you don’t always have to use your insurance.

Next claim. You can see your claims in your portal. Why is this important? It is important to know which claims have been processed. Sometimes providers will send bills before they’ve received payment from the insurance company. People who are used to paying their bills timeously will immediately pay them, not thinking that insurance hasn’t been paid yet.

Make sure that the statement you receive from your provider shows that the insurance was paid, and make sure that it reflects the same exact amount that your explanation of benefit or your claim status shows in the portal. I have seen providers not adjust the billing correctly. They may forget to give you the PPO discount for example.

Your explanation of benefits will say what your patient responsibility is. They cannot charge you more than what the patient responsibility is if they are in-network.

Next, you can also go and see if the right things were billed. Honestly, billing is done incorrectly all the time. Sometimes things are coded wrong, and there’s a wrong diagnosis, which can explain why your insurance didn’t pay. When you look at your claim and see something wasn’t paid, call the insurance company.

If you are struggling to set up your portal – I am here to help. I can do a zoom call with you. I walk you through the portal and show you how to do things so that you can see them and do them for yourself. Remember that utilizing the portal allows you to do your due diligence. Know what your co-pays are, know what your out-of-pocket max is, who’s in-network and who’s not in-network!

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