January 04, 2016 Healthy Living

Resolve to Take Control of Your Health Care

It’s the New Year, and for many, it’s a chance to start fresh. While you could resolve to spend more time at the gym, save more money, or learn a new hobby, what if you did something different – like, took control of your health care?

Health plans have, admittedly, gotten a bad rap in recent years. The skyrocketing cost of care is being passed on to consumers in the form of higher premiums, higher out-of-pocket expenses, and a reduction in benefits. In addition, more and more businesses have moved to high deductible health plans, which means employees are shouldering more of the health care bills. High deductible plans are also far more complex and require consumers to manage their health care dollars, shop around for the best prices, keep track of receipts, and file paperwork.

All of this can be a bit overwhelming, but there are simple steps you can take and resources you can take advantage of to make sense of your health care.

High Deductible Health Plans 02_high-deductible

If you have a high deductible plan, you’ll be required to pay a certain amount of money out-of-pocket before your insurance kicks in. Once that deductible has been met, the insurance company picks up the tab, or a percentage of it.

High deductible plans are often paired with health funding accounts. These accounts allow you to put aside pretax dollars to pay for medical expenses. But, don’t forget to save your receipts! When using a health funding account, you will need to submit receipts to substantiate claims.

Online Tools and Resources 03_online-tools

Much like banks and credit card companies, most health plans now offer online tools that help members manage their health care dollars. For instance, the secure member site allows users to check the status of claims, research costs and copays, submit receipts, check account balances, and pay bills.

It’s particularly important that high-deductible plan consumers track their claims and balances online. You wouldn’t go months, weeks, or even days without checking your bank account transactions. Why should your health insurance be any different?

Explanation of Benefits (EOBs) 04_explanation-of-benefits

An explanation of benefits is a great tool that helps consumers understand the cost they – and the insurance company – are being charged by a provider. When a provider submits a bill to an insurance company, the plan is then required to send the member an EOB.

The first and most important thing to know is that an EOB is not a bill. I repeat, an EOB is not a bill.

The document simply discloses how much the provider charged the insurance company, how much the insurance company has agreed to pay, and how much (if any) the consumer is responsible for paying. Keep these documents on hand, so if you do receive a bill from your provider, you can compare for accuracy.

Preventive Care 05_preventive-care

Too often, people don’t think about their health insurance until they’re sick. If you fall into this camp, you’re not alone, but you are leaving valuable health benefits on the table.

The Affordable Care Act requires health insurance companies to cover a series of preventive services at no out-of-pocket expense. This includes annual well visits, vaccinations, screenings, and more. The goal of these services is to catch potential problems early, and keep patients out of the hospital. Check with your health insurance company about which preventive services are available to you and your family, and resolve to schedule these appointments in the New Year.

Wellness Benefits 06_wellness-benefits

Finally, if your health plan offers wellness benefits, take advantage of them. So often we hear about members who don’t use these valuable benefits.

According to a survey by the Society for Human Resource Management, 80 percent of employers offer some type of wellness benefit. These can include health, fitness, and nutrition programs, lifestyle coaching, smoking cessation, and even massage therapy. In addition, some plans offer incentives and bonuses for members who complete these programs.

New Year, New You!

The health care industry has undergone tremendous change in recent years. While it’s easy to become frustrated with your insurance company, it’s important to understand that your health plan is your ally.

As you head into the New Year, I’m challenging you take charge of your health. Much like saving money for college, investing in the stock market, or even clipping coupons, it’s time for Americans to get their health care house in order. Once you do this, you’ll feel more confident and in control of your health.


Heart, Healthy Life, Bank, Business Team, Office and Business Meeting vectors by Freepik.

John D. Bennett, MD, FACC, FACP
About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

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