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Insurance Do’s and Don’ts

→ Understand Your Insurance
(Listed In Your Summary of Benefits)

  • Does your insurance require a Primary Care Physician (PCP) and referrals to specialists (including HTC or Infectious Disease doctors)? If so, have you seen your PCP.
  • Does your insurance cover your factor product and/or medication? Is your factor medical or pharmacy benefit?
  • Many insurances cover preventative health services free of charge. Does yours? (for example: annual physicals, flu shots, women’s health)

→ What are Your Out-of-Pocket Costs?
→ Do You Need Help Paying Them?

  • Review your deductible, co-insurance and co-pay costs. Can you afford them?
  • Do you have an out-of-pocket maximum? Do the deductibles, co-insurance, and co-pays count toward your maximum out-of-pocket costs?
  • Have you explored state programs such as BCMH (Ohio) or Children’s Special Health Care Services (Adults and Children in Michigan) to help with extra bleeding disorder expenses?
  • Have you explored the Manufacturer’s Co-pay Assistance Programs to help cover factor costs? (No income guideline required).
  • If you have Medicare, have you explored assistance with costs? Have you asked your HTC or Cascade social worker if you qualify?

→ Changing Plans?
→ Know Your Network!

  • Are all of your providers in your insurance network? (Primary care, Specialty Pharmacy, Home-Care)
  • Are you able to go outside of the network? If so, at what cost?

→ Multiple Insurance Plans?
→ Coordinate Your Benefits. It’s the Law!

  • Call all of your insurance plans and tell them about all other plans. They will find out about each other and could deny your claims. Nobody wants a big bill coming back at you!
  • Tell all of your health care providers about all of your insurance plans! There are rules about which plan is primary. Not following those rules could mean that you will be billed.
  • Understand that Children’s Special Health Care, BCMH or Medicaid are always the payer of last resort when you have two or more plans.

→ Insurance Changes?
→ Tell Cascade Right Away!

Let ALL of your providers know right away if your insurance changes. They may be out of network or your new insurance may require time consuming prior authorizations for your factor. Letting us and your HTC know could save you a longer wait to get your factor/medications in the future.