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Leveraging your health plan's Web site

Do you enjoy music on hold? "Live chat" at glacial speed? Punching your date of birth and ID number into a phone keypad only to repeat the information seconds later? If so, skip this list.

Otherwise, consider the top ten reasons to visit your plan's Web site:

  1. Find a physician, hospital or other provider (make a list, then check reviews on sites like Yelp). If your needs are complex, consider a large multi-specialty clinic or hospital-based practice with an integrated medical record.
  2. If you're in a plan where your primary care practitioner who controls your specialty referrals, and you're not a fan of your current physician (a sure sign is that you rationalize symptoms to avoid seeing him or her), check for PCPs that you might prefer who are accepting new patients. You may have to actually dial digits to make a change, but trusting your PCP is worth a call. In some plans, you may be able to designate a physician's assistant or nurse practitioner for some of your care; these can be options worth considering.
  3. For those recently enrolled in Medicaid, odds are you were assigned a PCP by your new plan; check your ID card. If you don't currently have a PCP, make an appointment with the one on your new card -- it's better to know if you click with him or her or not before a real need comes up, and you probably have some tests to catch up on.
  4. Order refills from a mail order pharmacy, usually via a link from the plan's site if you aren't already registered on the pharmacy's. To set up a Web account with a mail order pharmacy, you'll usually need the prescription number from a bottle they've sent you.
  5. Find a retail pharmacy from which you can get a 90-day supply (preferable for long-term meds) or a shorter-term fill
  6. See if the med(s) your doc recommends are on formulary and how much you'll pay for them. If a med says "prior authorization required," allow extra time for the first fill. On some plan sites, you can also see under what circumstances a prior auth (PA) will be approved for a given medication.
  7. Check "medical policy statements" if you're not sure your plan covers a given treatment, for the circumstances under which equipment and specialized services are covered
  8. Keep track of where you are in terms of meeting your annual deductible and out-of-pocket maximums. Sometimes you can be strategic about pushing expenses into the beginning of a plan year, or making the most of your last plan month of the year. Remember that the "plan year" is not necessarily a calendar year; your plan's Web site can remind of when yours ends.
  9. Access a summary of benefits, clarifying the percentage or flat amount you pay for services and drugs each year. This can change from year to year.
  10. Link to complementary health and wellness benefits and discounts for plan members, from pet care to fitness centers to massage therapy
  11. And the bonus-- many plans have a free nurse line you can call when you're not sure what to do next (of course, if things are really out of control, or could be, dial 911 instead). If you don't have a refrigerator magnet with the number, print it out from the plan site. The number/hours/street address of the closest urgent care clinic that your plan reimburses (many plans now cover these under certain circumstances since it can save you a more expensive ER visit) is another item to place next to the nurse line.
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