Transcript Using insurance in the HIP program - LA HAP

Welcome to LA HAP!
What is LA HAP?
A part of the
Ryan White
program
Louisiana Health
Access Program
L-DAP: Medicine
HIP: Insurance
premiums and
cost-shares
How do I apply?
• LA HAP application: www.lahap.org
• Do application every 6 months
– No health insurance? LA HAP pays for medicine
– Have health insurance? LA HAP pays for
medicine AND premiums, doctor visits
LA HAP works with your health insurance.
LA HAP is NOT health insurance.
Do you want health insurance?
1) Shop for, sign up for
health insurance
2) Do LA HAP application
3) Insurance company sends
you a “Schedule of Benefits”
and an insurance card
4) Send your insurance plan information to LA HAP
5) Ramsell sends you a “LA
HAP card”
Open and save EVERYTHING!
Open and read now = Less problems, less bills later
•Copy of LA HAP
application
•Copy of HIP approval
letter (ask your case
manager)
•Copy of LA HAP card
(for getting medicine)
•Schedule of Benefits
(SOB)
•All Explanations of
Benefits (EOBs)
•Copy of insurance
card
•Medical information
•Prescription
information
•Every bill you get
Bring: insurance card
Bring: Insurance
card, LA HAP card
Before you go to the doctor (1)
• Will I have to pay?
LAHAP CAN pay for…
LAHAP CANNOT pay for…
Most medicines
Erectile dysfunction drugs, nutrition
supplements, OTC drugs, cosmetic
drugs
Doctor visits
In-patient hospital stays
Lab work
Discount health/pharmacy plans
Dental premiums
Dental cost-shares
Vision premiums and services IF
they’re part of a bigger health plan
Vision premiums and cost-shares if
they’re part of their own plan
Tests
Products or services your insurance
company doesn’t cover
Before you go to the doctor (2)
• Does my insurance cover it too?
– Look in your SOB, or
– Call your insurance company.
Make sure BOTH
LA HAP and the
insurance
company cover it.
Before you go to the doctor (3)
• Call them to explain what HIP is.
• They can call HIP at 225-927-1269 and ask to
speak to Katie. She can explain what HIP is.
• The doctor should bill HIP for any “costshares”: co-pays, coinsurance, deductibles.
At the doctor’s office
• A deductible is the money you (or HIP) have
to pay before your insurance company will
start helping with costs.
– Your SOB will tell you what your deductible is.
– Example: you have a deductible of $2000. That
means that each year, you (or HIP) have to pay
$2000 of your own money at the doctor’s office
before your insurance company starts paying.
At the doctor’s office (2)
• A co-pay is the money you (or HIP) pay the
doctor/pharmacy the day of your visit.
• For example, a doctor might ask you to pay
$20 for a visit, and then they will send a bill to
the insurance company for the rest.
At the doctor’s office (3)
• Co-insurance is a part of the total bill you (or
HIP) pay to the doctor/pharmacy the day of
your visit.
• For example, a pharmacist might ask you to
pay 20% of the cost of a drug, and then they
will send a bill to the insurance company for
the rest.
At the doctor’s office (4)
• Ask questions.
• Bring a friend or family
member if you like.
• Ask when you should come
back.
• Did you like your doctor? If
not, you can choose a different
one.
After your visit
1) Doctor sends bill to insurance company
2) Insurance company pays bill
3) Insurance company sends you an EOB
(“Explanation of Benefits”)
4) If your insurance company didn’t pay the
whole bill, your doctor may send you a bill
too.
5) Call HIP (225-927-1269) about this bill and
ask if they can help.
Remember!
• If you have questions, ask!
Always politely!
People will try
harder to help you!
– About using your insurance: the insurance company
– About your LAHAP application: LAHAP at 504-5687474
– About a bill: your doctor, or HIP at 225-927-1269.
• Be patient!
– Sometimes things can be slow.
– You can call if you think something’s wrong.
• Open your mail and save everything!
Thank you!
Alicia Cooke
504-568-7428
[email protected]
Questions? Call me!