To our Vitalize Community,
Yearly, we try to give you an update about what to expect at Vitalize and from your insurance in the coming year. This is getting tougher and tougher to predict with health insurance companies make more and more mid year changes to coverage, provider billing and prior authorization requirements.
At Vitalize, we have always attempted to remain in-network with all major carriers in order to serve as many Portlanders as possible. As we have worked with different companies over the last 10+ years in business and in insurance billing, we have learned that some companies make it their business to avoid paying for rendered services while others go above and beyond to provide great customer service and support to both patients and providers alike.
Shopping for an insurance plan can feel overwhelming, comparing apples to oranges and all with nothing feeling quite right. For 2022 our favorite company is Pacific Source. This is a local company with amazing business practices, things we don’t see many companies doing, like avoiding adding prior authorization to their plans. Our providers and their families will be covered by Pacific Source in 2022. We will remain in-network with Pacific Source as well.
From Nov 1 2021 until Dec 15 2021 you can select a health insurance plan. This is called ‘open enrollment’ and allows for coverage to begin Jan 1 2022. If you miss this deadline you can still sign up for insurance, you will just have a few weeks uncovered. There is a deadline and mid year changes have to meet certain ‘life change’ criteria in order for mid year plan sign up.
Of course you have likely heard of https://www.healthcare.gov but we recommend that you call the health insurance carrier you are considering working with for 2022. Ask them the following questions;
Ask about the in network deductible (the total you pay prior to access to most or all of your benefits)
Ask about the total out of network deductible
Ask about your out of pocket max for they year (the total out of pocket costs, not counting your premium, which you are responsible for prior to your plan covering ALL expenses, this is usually a large number)
Ask whether coverage for your health care providers is part of the plan and if those providers are in or out of network with the company
Ask if the company offers coverage for the services you want both in and out of network and whether you must meet your deductible prior to accessing coverage for those services
Ask if prior authorization or medical necessity review is required in order for payment to be issued for services listed as covered for the plan you are considering
Be sure that your regular prescription medications are covered and that any maintenance diagnostics or procedures you know you need to have are also covered.
If you know you will have a surgery, or for emergency purposes, ask which hospitals in your area are in network
Additionally, you might like to know whether the plan offers a copay or co insurance and how much it is for the different providers or services you know you will seek out.
Compare your options. It’s time consuming but very important. If you know you are going to have higher needs, check on options with more coverage. We can’t predict all healthcare needs, but we can often predict prevention, maintenance, monitoring, and the day to day needs we hope to have met by our healthcare coverage.
We are here for you, if you have questions, comments, concerns, or suggestions. Good luck on your hunt for coverage. Remember, you are dealing with a system that has both its pros and cons. We can only do our best with what we have.
As for Vitalize, we plan to go out of network with CHP and therefore Kaiser at some point during the 2022 year. Kaiser and CHP have not previously offered out of network benefits. We also plan to go out of network with United Healthcare for acupuncture during the 2022 year. We will still bill out of network for United Healthcare plans for all services.