It pays to know the ins and outs of your health insurance plan so you won’t be caught off guard. Health insurance participation varies from plan to plan and there are even variations within plans that you may not be aware of. Educating yourself on how your insurance plan works will help you make your health insurance dollars go farther.
When you don’t know what you don’t know it can be very challenging to find the pertinent questions to ask. It can be difficult to understand the different health insurance plans and what they will and will not cover. There may also be restrictions on which doctors or clinics you can use. Getting the answers to the following four questions will help you understand how your health insurance participation will be affected by different health insurance plans.
- What Are the Benefits of This Insurance Plan? Some plans will cover all of your medical requirements, from preventive care to eye exams and some dental procedures. Others will not. Your family may have medical needs that may or may not be covered by the insurance you are considering. It’s wise to take into account the needs of family members when looking at the benefits of any insurance plan.
- What Is My Financial Responsibility? You may have a copayment or a deductible which will affect your insurance participation. A reasonable flat fee may be required for each office visit. This is a co-payment. Other plans require that you pay a certain amount up front before the insurance kicks in to cover costs. It is important to know ahead of time if you will need to spend hundreds of dollars of your money first to cover the deductible, or if you will pay a flatfee every time you have to see the doctor.
- Can I Stay With My Present Doctor? This is an important question for many who are considering changing their Participation in some plans requires that you see only the doctors aligned in the plan to be covered by the insurance. These are “in-network” providers. Any medical care out of the network either needs to be pre-authorized or you will pay for it yourself.
- Is Routine Care Covered in My Insurance Participation? Annual physicals are considered preventive or routine care. Some plans cover these visits and others do not. In some cases part of the visit may be covered but not all of it. Routine procedures include Mammograms, pap tests, and immunizations along with other tests or procedures. Find out what’s covered and what things you may need to pay for yourself.
Health care insurance participation can be a little tricky if you don’t know the details of your plan. Be sure to ask questions so that you have a clear understanding of what your health insurance will cover.
Don’t be caught by surprise. At PCP for Life in addition to providing you and your family with excellent medical care, we also have business staff who can help you with your insurance claims. Contact us for more information.
