The Insurance Game: The Ins & Outs

by | Jan 6, 2017 | Insurance, Wellness Exams

As open enrollment prepares to close for the year, it is an apt time to review your benefits.  More than that, this is an opportunity to learn a little about how insurance works.  This may be review, but hopefully will spark some insight into how to better choose and use your insurance plan.


This is your monthly payment that goes to the insurance company regardless of how much you utilize your insurance.

Out of Pocket Expense

This is money that you directly pay for, either because of a deductible not being met or because the service or product is not covered by your specific insurance plan or because the provider you are working with is not a covered provider.  General, nutritional and herbal supplements are not covered by insurance.  Some plans do have a Maximum Out of Pocket, at which point the insurance plan will take over all covered expenses.


This is how much you must pay out of pocket before your benefits kick in.  Note that different aspects of coverage may or may not apply to a deductible.  For example, with some plans labs and prescriptions are paid even before the deductible is met, but in others, patients cover the full cost of these until the deductible has been met.

Get a Plan that Works for You

Essentially, healthcare costs that exceed your premium generally start high at the beginning of the year. They often lower after your deductible is met and better coverage kicks in.

Many people have a hard time working with online enrollment programs.  Working face-to-face with a good insurance broker or care coordinator can be helpful in finding a plan that meets your needs so you aren’t over spending on a high deductible when you know you have health needs that require regular visits and lab workup.

Coverage for Natural Medicine

If you have a preference for natural or alternative health care, a broker can also help you find a plan that covers the types of providers you tend to work with. Checking with your insurance company regarding coverage for alternative medicine providers, such as naturopaths, acupuncturists, and chiropractors, can be tricky; the language you use must be specific.

Just because the provider is in network does not ensure that you have benefits covering his/her services.

We recommend asking if the type of provider you wish to see is an “Allowed Provider Type” under your plan.  

Learn more about NWIM’s insurance options.

We are happy to provide an Insurance Verification form to help you determine your coverage.


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