Health insurance is extremely complicated. Please allow the following to help you better understand your health insurance.
What you should know:
-Marketplace/Exchange/Obamacare:
None of our physicians have a contract with any of the insurance exchanges
-Participating Provider:
This means my physician has a contract with the insurance carrier. To find out if your physician is a participating provider you must call your health insurance company to verify
-You should know that every health insurance PLAN varies.
Maybe you and your neighbor both have Blue Cross Blue Shield. That does not mean you have the same coverage. When an employer decides to purchase health insurance they are asked to select a type of coverage. Some employers may choose to have maternity benefits and some may not. Many of these decisions are based on employee status and cost.
-You should know whether or not the physician you are about to see is a provider of your plan. Provider means the physician has a contract with your health insurance company and accepts a contracted rate for specific services. If your physician is considered a provider for your plan, you (as the patient) will receive an adjustment on your statement to reflect the contracted costs. If you decided to see a non-provider some plans do allow that, but you should understand that you will NOT receive that adjustment on your statement, and you may be responsible for the balance of the amounts billed by the physician which are in excess of that reimbursed by your plan. Please consult your insurer to determine how this will affect you as the patient or responsible party.
-You should know the amount of your co-payment.
Your co-payment is money your insurance has determined must be paid to your physician at the time of the service. This amount varies. Most often, the amount will be in the front of your health insurance card. Also, you should know there is a PCP (primary care physician) co-payment and a specialist co-payment. Usually the co-payment for a specialist is higher. Our physicians are considered specialists.
-You should know the amount of your annual deductible.
A deductible is the amount of money your health insurance holds the insured responsible for every year. This amount varies. This amount must be paid by the insured before the insurance begins to pay. Usually, the deductible is applied when having a procedure such as an MRI, X-ray or surgery.
-You should know what laboratory/radiology facility your insurance plan requires you to use.
Some insurance companies want you to use specific facilities for any testing done outside our office. Whenever you are given an order for ANY testing you should call your health insurance and ask them is the facility you were sent to is covered by your insurance plan. Our office tries to accommodate all insurance carriers but some are very specific therefore we suggest you call your insurance company and verify.
-You should know that knowing and understanding your insurance benefits is the patients responsibility.
Every insurance policy is SO unique that it makes it impossible for any physicians office to know the details of each plan. Be proactive, find out all the important information mentioned PRIOR to your appointment. Being aware of your benefits will allow you to get the best benefits from your insurance policy. Not knowing your plan may result in higher expenses than necessary!
We hope this information has been of some assistance to help you understand what is important to know about your health insurance.
