It’s a new year and most insurance plans are about to reset on January 1st. That means it is a great time to get refreshed with your insurance plan options and a great opportunity to set up a care schedule in 2020.
Let’s talk about health insurance!!
It still shocks me how difficult it can be to navigate our healthcare insurance. It wasn’t until I started taking courses on insurance billing that I truly started understand what healthcare benefits look like and how to use them. These classes were geared towards practitioners being able to bill insurance companies for their services but this basic knowledge is critical for anyone who has and uses insurance.
I’m no expert, but I’m here to help you navigate.
The best way to start this conversation is by breaking down terminology. So, here we go!
Deductibles are specific dollar amounts that need to be met before insurance will kick in and start paying. Basically, you pay out of your own pocket for the service until you hit your deductible total. You can think of them like financial hurdles. Inconvenience for you, but convenient for the insurance company.
In-Network versus Out-of-Network
Ask your provider.
Insurance plans generally have two separate levels of coverage: In-Network coverage and Out-of-Network coverage.
In-Network providers have an agreement with your insurance company and that agreement dictates how much the insurance company is willing to pay for the services provided. The perk of seeing an In-Network provider is that there is often no deductible to meet or a lower deductible. And it is easier to assess the services without other complications or financial roadblocks (deductibles) applied by your insurance company.
Out-of-Network means there is no dictated service agreement between the practitioner and the insurance company therefore the insurance company can pay whatever they like or not pay. Often there’s a higher deductible to be meet before insurance will pay for out of network services.
This is all very specific to your insurance plan. Some plans have equal coverage for both In and Out of Network providers. Some plans won’t allow you to see Out-of- Network providers, some plans reimburse the provider at higher rates when you are Out-of-Network. It can feel like the Wild West sometimes. This is where the importance of knowing the specifics of your plan come in!
Co-Pays and Co-Insurance.
Co-Pays are the amount of money that you pay upfront out-of-pocket to see your practitioner. This is considered your portion of the payment for services rendered. Insurance company will then pay the amount they decide to the provider. The amount paid to the provider varies from insurance company to insurance company and plan to plan. What they pay is generally not equal to what is actually billed, but usually a percentage or predetermined amount.
Co-Insurance is percentage based payment. With Co-Insurance the insurance company agrees to pay a percentage of the visit and you are liable for the remaining percentage. For example, you many have a 20% Co-Insurance, so you are responsible for 20% of the visit cost and