When you first receive your health insurance, it’s essential to take some time to familiarize yourself with the plan. Review the policy document, and make sure you understand what is and isn’t covered. You should also find out the deductible and co-payments for different services.
If you have any questions about your policy or need help understanding how to use it, don’t hesitate to call the insurance company’s customer service line. They will be happy to help you get started. This way, you can maximize the benefits you get from your insurance plan.
Determining if Your Policy Covers Surgery
One of the most important things to do when considering surgery is determining if your health insurance plan covers it. Many policies have a list of covered procedures, while others will instead have a list of excluded procedures. You should also consider any co-payments or coinsurance requirements for each procedure.
For example, if your policy covers surgery 100%, you’ll still need to pay your deductible and any applicable coinsurance fees. Don’t give up if you don’t immediately see the details of the procedure you’re looking for. Health insurance companies keep their policy documents organized by procedure code.
However, it can be challenging to find the correct code if you aren’t sure of the procedure’s name. Don’t waste time with this: instead, call customer service, and they’ll help you find what you need. This way, when you’re already in the urgent care center, you won’t have to make another phone call to your insurance company.
Finding a Doctor in Your Network
It’s crucial to find a doctor covered by your health insurance plan. If your health care provider isn’t in your network, you’ll be stuck paying significantly more for any medical services they provide to you. You might also need pre-authorization from the insurance company to see certain doctors and get certain types of care.
You should also find out if the doctor is available to you 24 hours a day if they offer after-hours care, and how many days you’ll need to wait for an appointment. Your insurance company may have a list of doctors covered by that plan. If not, check with your employer or call customer service for help in finding one.
Using Health Insurance Tools on the Internet
If you’re like most people, you can’t afford to pay thousands of dollars in medical bills out-of-pocket. But with all the different choices when it comes to health insurance plans, understanding these details can be complicated. Fortunately, there are many tools available online that can make it easier.
Insurance companies often have sites where you can look up your plan to see what’s covered and what isn’t. You should also find information about the deductible, co-pays, and coinsurance for different procedures or services. Some companies even offer calculators that let you determine how much a procedure will cost or how much your monthly premiums are.
Don’t forget to explore the tools available from your employer as well. Many large companies have extensive benefits websites where you can find information about all of their employees’ benefits. This way, you can avoid any unpleasant surprises when meeting deductibles or paying for services.
Understanding Explanation of Benefits (EOB) Statements
Another vital tool is the Explanation of Benefits (EOB) statement. Once your insurance company pays for a medical service, you should receive an EOB from them in the mail. It will have detailed information about how much they paid and when they paid it.
You should keep any EOBs that you receive, but also be sure to compare them with your credit card statement. Sometimes medical services are marked up before being paid for by the insurance company, which is why it’s good to have an idea of what they should cost if you have to pay them out-of-pocket yourself.
If you’re unsure whether your plan covered medical service, take a look at the EOB and see if there’s any mention of it. You should also see if you can find out how much your plan pays for that service and what percentage is expected to be covered by you as the patient (e.g., 20% coinsurance).
You may notice an entry on the EOB that says “adjustment.” If you don’t, it might be marked as “pending.” This means that your insurance company is considering whether to pay for the service. Don’t worry: sometimes they do decide to cover it after all!
If you have any problems with your EOB or determining what your plan covers services, call the customer service number on the back of your health insurance card. They should be happy to help you out and answer any questions you have.
Understanding your health insurance plan can be complicated when it comes down to it. However, the more information you have, the better off you’ll be when it comes time to interact with your insurance company.
