Ok, so let me be the first to understand that insurance is complicated. It has it's own set of words and definitions and it isn't always easy to understand. So what should you do when you are getting insurance? Well-Ask.
1.) Know your benefits. If you are going to the dr for any reason, call your insurance company and get your benefits quoted to you. Yes, your dr will also check, but you need to be informed. The best way to not get a nasty surprise, is to know what to expect.
2.) Understand that your insurance company has it's limits. There is to date, no standard pricing lists for medical services, your insurance company cannot tell you exactly what you will be paying when you go in for medical services
3.) Know the right way to ask your questions, so you get the answers you need. Call, go on your insurance website, whatever, but find out which dr is contracted with your insurance company before you see a dr. Find out how your insurance company deals with emergency treatments where you don't have a choice in who you see.
4.) Remember that each insurance company is bound by the laws of the state. If it is state law that a dr can bill you upfront for services, then they can. Your insurance company cannot do anything about it. So do your research and know the laws for your state.
5.) Set aside the time to contact your insurance company. If you have 15 minutes or less, it's not a good time to call. Plan ahead, be prepared to hold at some point in the call, understand that your plan is not the only plan that your insurance company handles and don't be nasty about it when your customer service rep needs to look deeper into your plan to answer your questions. It is better to be patient and get the answers you need than to get the wrong information or no information at all because you couldn't be bothered to plan ahead and call at a time when you could be patient
6.) Have your information when you call and enter it in the phone when it asks for it. Don't call in and say "Hi, this is sara, I have a general question..." There is no such thing as a general question when it comes to your insurance. All plans are specific. By entering your information when the horribly annoying automated system asks for it, you are 90% more likely to get to the right place the first time. The rep you are talking to will be able to pull up your info much faster and you will have a much better experience
7.) Know the terminology:
-Deductible: the amount of money that you are responsible to pay before your insurance will kick in on medical services not covered by preventative care laws or copays
-Copay: The set amount of money you pay up front for office visits, urgent care and emergency room. This does not count toward your deductible in most cases and only covers services that are part of the regular office visit, so paying a copay does not mean you will not anything else
-Coinsurance: This is amount of money you pay along with your insurance company. After your deductible is met, your insurance company will pay a certain percentage of your medical bills, say 80%. The remaining 20% is your responsibility and is called your coinsurance
-Out of Pocket Expense: This is the amount you will pay out of pocket after your deductible is met. It includes your coinsurance and in some cases your office copays
-Allowed Amount- This is the amount that your insurance company will pay for a service. If your dr is contracted with your insurance company(aka In Network) then they have to accept this amount and cannot bill you for any charges over that amount. IF however your dr is NOT contracted with your insurance company (aka Out of Network) then they can bill you for any charges over the allowed amount and your insurance company cannot do anything about it.
-In Network- contracted with your insurance company
-Out of Network- not contracted with your insurance company
There a lot of other terms, but those are the main ones that everyone should know. Basically what I am saying, is ask your questions ahead of time, and ask your insurance company, not your best friend or your agent or your doctor. The best way to be prepared is to be informed.
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