How to get the most out of your health plan coverage

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What is your health insurance company hiding from you?  If you’re like most of us, lots of perks and benefits — pricey treatments you may not know you qualify for.  But it’s actually mandated by your state or federal coverage laws.

One woman figured out how to squeeze the most out of her health insurance.

Megan Maddox can make the perfect pastry at Aux Merveilleux in the West Village,  but like most of us, probably doesn’t know all the ingredients in her healthcare plan.  “It’s like a foreign language because it’s the first year I’m off my parents plan. It’s like a nightmare!”

Since the Affordable Care Act rolled out, lots of changes have come to health insurance plans, and you may not even know all the benefits of your plan.  I asked Maddox about her coverage: can you get chiropractic care?  “I don’t know,” responded Maddox.  Next: acupuncture?  Again the same answer from Maddox, “I don’t know.”  What about massage therapy?  Still the same refrain, “I don’t know.”

But there is someone who does know.  Ginalisa Monterosso, with the Medicaid Advisory Group weighed in.  “We really need to be as a consumer to be inquisitive about the type of health care coverage we have.”  For 25 years, Monterroso has been guiding consumers through the often maddening maze that health coverage can be.  She advises that we may have a whole lot more coming our way than we thought, like “Chiropractic services, infertility, weight loss, acupuncture.”

Bariatric surgery, which can cost upwards of $20,000, although an elective procedure, is covered in both New York and New Jersey. Infertility treatment?  That’s covered, too. Looking to reap the benefits of acupuncture or chiropractic?  Chances are there’s money for that in your plan as well.  Any state licensed physician has their services covered, which is how all these “newer” treatments now get benefits, too.

Maddox lamented the constantly changing landscape of health plans.  “Every year my co-pay would change, half the time my doctors wouldn’t know what it was.  It’s complicated!”  And Monterosso says while it’s not one size fits all, you can crack the code to your plan’s secret benefits by hitting the “Summary of Benefits” pages, where the plans are mandated to lay out all the coverage you’re entitled to in the fine print.

A few quirks include that female contraception gets covered, while male contraception like condoms and vasectomies generally does not.  And Monterosso reminds us that sometimes we have to be a bit of a detective, perhaps calling the doctor’s office and asking them if a procedure is covered before booking an appointment.  But it pays off especially when we’re talking about procedures that cost tens of thousands of dollars.