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Making the most of your Health Insurance

The end of the year holds a lot to look forward to, pumpkin spice, turkey dinners, and fancy decorations. But it also means Open Enrollment season for insurance companies. Now is the time when you can change your health insurance plan or company.

You might be surprised to find out that many insurance companies electively choose not to offer and pay for a variety treatments. We want you to get the care you deserve, but it can be hard to know who offers what. So we wanted to clarify some points for you regarding the services and treatments we offer here at Reflex.

  1.  Is your insurance company In-Network with Reflex? These are companies who will pay for our services at the highest co-insurance rate (which means the smallest out of pocket amount for you). We are in network with the following: Aetna, BCBS, Humana, Medicare, MODA, Pacific Source, Sterling Premier, United Health Care, Tricare, Cigna, US Benefits and Mail Handlers Benefits Plan.
  2. A few insurance companies won’t pay for Hyaluronic Acid (HA) injections at all, regardless if the physician is in network: Providence will only pay for HA injections of Euflexxa (which is better than nothing), unfortunately Kaiser and LifeWise of Oregon will not cover HA injections at all.
  3.  Then there are those companies that will pay for HA injections as long as you can prove that steroid injections don’t fix your knee pain, which means you’ll have to get a steroid shot before they’ll let you try anything else: Aetna, Moda, and US Benefits.


Let’s say you’ve switched your insurance company to one that you know pays for HA injections, and you’ve found a provider that is in-network…now what?

All services will fall to your patient deductible until it has been paid in full for the year. Once your deductible has been met insurance will pay for services at the co-insurance rate until the Out of Pocket (OOP) max has been met for the year. Once the OOP Insurance billmax has been met insurance will pay for services at 100%. Some plans count your deductible towards your out of pocket max, but not all do, make sure to check as that can make a huge difference in how affordable you plan actually is.

There are two ways that we’ve seen patients take advantage of this set up. The first is to take care of all your health issues at the beginning of the year. Sure this means you’re paying some bills right after the holiday season, but you’ll quickly knock out your deductible, making your insurance company pick up most of the bills until you hit your OOP max for the year. The sooner you hit that the sooner your insurance company will be picking up the entire tab.

The second thing we see often is that by this time in the year patients have already met their deductible and even OOP max. Which means now is the perfect time to take care of any health issues you may have been trying to wait to see the doctor about. Get your check up, see a specialist, and take advantage of all those chiropractic or physical therapy appointments you’re allotted every year. You won’t even have to pay for co-pays.

We highly encourage you to take a look at your insurance plan and make sure it’s right for you at this time in your life.

Maybe you’re getting older and you need more coverage than you did 5 years ago when you first signed up for your current plan. Or maybe your insurance company as recently made changes to the treatments they cover and they no longer pay for something you assumed was a given. Since the addition of the Affordable Care Act many insurance companies have made drastic changes to their insurance plans, some for the better and some for the worse. Make sure that you are informed and making the best choices for you and your family.

Still have questions about whether now is a good time to come see us? Call to talk with an insurance specialist in our office 503-719-6783.