GEC Southwestern Information

How to use your health insurance and more helpful links.

Steps on how to use your health insurance

What is insurance?

Health insurance helps pay for your health care. It can help cover services from a cough to a serious illness or injury. 

How do I use my policy?

You should review your brochure for your plan’s benefits and limitations. Your insurance plan requires you to stay within the provider network UnitedHealthcare (UHC). Your insurance requires you to receive your care from certain doctors, Teladoc/Telemedicine, urgent care facilities, and hospitals, as most plans do. You will give your insurance information to your Teladoc/Telemedicine, urgent care, doctor, or hospital and pharmacy when you go for care or fill a prescription. The doctor or hospital will bill your insurance company for the services you receive. You will need to complete a claim form 

Please see your brochure to review the details of your health insurance benefits.

What do I use an insurance card for?

Your insurance card proves that you have health insurance. It contains information that your doctor or hospital will use to get paid by your insurance company. Doctors usually make a copy of your insurance card the first time they see you as a patient and they might ask for your (proof of identification) as well. 

Your card is also helpful when you have questions about your health coverage. There’s a phone number on the back, that it you can call for information by contacting Customer Service.

What's a network?

Doctors and hospitals often contract with insurance companies to become part of the company’s “network.” The contracts spell out what they will be paid for the care they provide. If you go to a doctor in your insurance company’s network, you will pay less out of your own pocket than if you go to a doctor who doesn’t have a contract with your insurer. It is important to consult the plan’s network before seeking care. Your network is UHC or UnitedHealthcare. https://www.wellaway.com/en/providers/

How do I find an urgent care, doctor, specialist or hospital?

You can call your insurance company using the number on your insurance card or at  https://www.wellaway.com/en/providers/

Claims information

You 

Customer Service

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What do I do if a medical issue occurs?

If you or a family member gets sick but, it’s not an emergency, you will want to utilize Teladoc/Telemedicine first.  Teladoc/Telemedicine   is a virtual doctor’s visit, and you are not subject to your deductible for this visit. This should be your first step to seeking care. https://www.teladoc.com/ 1-800-Teladoc (835-2362) you will need to register with Teladoc before the visit. Teladoc doctors are available 24/7/365 to provide quality care for non-emergency health issues through the convenience of phone or video consults.

Secondly, you can choose to go to an urgent care center. These centers can treat some serious injuries and illnesses and typically, you won’t wait as long as at the hospital.  At urgent care centers, you can go there to get stitches for a bad cut or to be checked if you have a high fever or sore throat.  Some urgent cares will take x-rays if needed.

If you are having a life-threatening medical emergency, call 911 or go to the local hospitals’ emergency room. You may be subject to an emergency room copayment if utilize an emergency room visit.  Please review your brochure for details. 

How do I find a pharmacy (to fill a medication/prescription) in the network?

At the time of your doctor’s appointment, you might need a prescription. This will need to be filled at a pharmacy.  You will need to provide your ID and insurance card to have your prescription filled. If you need to pay out of pocket for your medication; you will need a copy of the prescription and the receipt showing that you paid for the medication.  To find a local pharmacy: EHIM | PBM Solutions | Group Health (ehimrx.com)

How much do I pay?

Paying for health care involves two types of costs. Deductibles and copayments. Your provider will submit your claim to UnitedHealthcare. They will process your claim and an EOB (Evidence of Benefits) will be sent to you. If you owe a deductible and/or copayment. You will need to pay that amount to the provider, hospital, urgent care etc.

How much does the insurance company pay?

Health insurance has a deductible. That’s the amount of money you must pay before your insurance provider will pay. For instance, you might be responsible for $350 in medical bills before your insurance kicks in. 

Once you’ve met your deductible, the insurance company will begin to share in the cost of your medical bills. 

Copayments, or copays for short, are fixed amounts you pay for covered services. For example, you might have a $350 copayment for an emergency room visit in addition to your per injury/per illness deductible. 

What if I need a specialist?

Check to see if the specialist is in your insurance company’s network. If they aren’t, you might have to pay a bigger part of the bill or perhaps the whole bill. 

Next steps after your doctor’s visit

Submitting a Claim Form

  • If you have paid out of pocket for your services, you need to submit an itemized bill for reimbursement. The following is needed:
  • The provider’s Tax ID number
  • Procedure/diagnosis codes
  • Providers name and address
  • Proof of payment 

 

Pre-Certification