Enrollment season 101!
By Hiba Fatima CHAA, Patient Care Manager
Read this before choosing your 2025 health plan.
It's that time of year again! Before you cuddle up with a cozy blanket, light your favorite candle and sip on your Pumpkin Spice Latte, let’s talk about enrollment season.
What is open enrollment?
Open enrollment season is the time of the year when you get to select your health benefits plan for the upcoming year. If you had a high deductible plan with little or no acupuncture coverage this year, you can change that! Read on for guidance on choosing the best plan to make the most of your hard earned benefits.
Understanding the basics
Before we dive into the nitty-gritty, let's go over some key terms. These will serve as your compass in choosing the right plan for your needs.
In-Network:
Definition: In-network refers to medical providers who have contractual agreements with health benefits companies
The Scoop: Health benefits companies entice providers to sign contracts by listing them in their database, ensuring a steady influx of new patients
Trade-Off: In-network practices are often high volume, resulting in shorter patient visits and less personalized treatments
Out-of-Network:
Definition: Refers to medical providers who do not sign contracts with benefits companies. This means they are not under an obligation to accept a set amount per visit
The Scoop: Out-of-network providers' highest priority is the patient. They can operate with lower patient volumes, thus spending more time to provide higher quality individualized treatments
Trade-Off: The billing process may seem more complex. This is why the Acuworx billing team is with you every step of the way. Our expertise has helped thousands make the most of their hard-earned benefits
Insight: In-Network providers have a contractual obligation with insurance companies. They must balance the patient care against their contract requirements.
This usually means in-network providers must accommodate a higher volume of patients with less time per visit.
Deductible:
Definition: The deductible is the threshold the claims must reach in order for the insurance payments to kick in
Pro Tip: If you plan to utilize your benefits extensively, lower deductible plans tend to offer higher levels of coverage
Visit Limit:
Definition: The visit limit is the maximum number of sessions your insurance will cover in a plan year.
Pro Tip: Unused visits don't roll over to the next year, so be sure to make the most of them.
Reset Date:
Definition: When the deductible and visit limit accumulations go back to zero. For most plans, this happens on January 1st.
Pro Tip: Align your care with the reset date, especially with high deductible plans, and be sure to use all remaining visits by December 31. You lose all visits that are not used by the reset date
HELPFUL PRO TIPS
Benefit details are typically provided in a PDF format. Use "Control or Command + F" to quickly find specific benefits, especially in the "Excluded services" section
If you need to use your "use-or-lose" FSA or HRA, rest assured that we accept all spending accounts at Acuworx
Our billing team is available to assist you in making the most of your benefits. Feel free to fill out the benefits verification form for a courtesy insurance check
For more information, reach out to us via email at billing@acuworx.com or give us a call at 201-724-3998
ACTION STEPS:
Choose the lowest deductible plan which includes acupuncture benefits
Schedule any unused visits before visit limits reset on January 1st
Pick the right plan for your needs
Enrollment season is your opportunity to take control of your health and wellness. By understanding the basics and following our pro tips, you can make informed decisions that maximize the value of your hard-earned benefits. Don't rush into choosing a plan—Read, research, and make the most of this enrollment season.