Understanding your health insurance benefits can be tricky. It’s
important to fully understand your benefits to make better financial
decisions and to be prepared in the case of an emergency.
1. What is your deductible?
A deductible is the amount of money you have to pay towards
your health care costs before your health insurance starts to
pay.
2. To what services does your deductible apply?
Your deductible may not apply to all services. Frequently, the
deductible does not apply to preventive services. Check with
your insurance company if you are not sure which services apply
to your deductible.
3. What is a co-pay?
Most health insurance companies use a co-pay to place some restraint
on the utilization of health care services. A co-pay may be
a specific dollar amount (for example, a $5 co-pay) or a percentage
of the charge (for example, a 20 percent co-pay). Different
health insurance companies have different co-pays. You should
know your co-pay.
4. Do you need a referral?
Some health insurance plans have a panel of physicians who will
provide care for the patients within a particular health plan.
If you want to see a physician outside of this panel, you will
probably be required to get a referral. You should have received
a book from your insurance company that lists which physicians
participate in your health plan. If the physician you want to
see is not listed in the book of participating physicians, you
probably need to get a referral to see this physician.
5. Preventive Exam (Annual physical)
Some health insurance plans pay only if you have a medical problem.
Other health insurance plans pay a certain way if you go to
the doctor for medical problems and a different way if you see
the doctor for preventive services
6. Prior authorization/pre-certification
Many health insurance plans require pre-approval for certain
procedures (for example, CAT scan of head, a visit to the emergency
room or convenient care center at a hospital) and/or pre-certification
if you need to be admitted to the hospital.
7. Medical Necessity
Many health insurance plans use the term "medically necessary".
They claim to only pay for "medically necessary" health
care.
8. Who files the insurance?
It is usually the responsibility of the insured to file the
insurance claim. Check with your insurance carrier if you are
not sure.
9.What is covered by my health insurance?
It is your responsibility to contact your insurance company
to obtain this information. There are many different plans offered.
10. Any changes?
If there has been any change in your health insurance coverage
since your last visit to you doctor, be sure to report these
changes to your insurance carrier. These changes may include
any name change, address change or change in the insurance company.
