The insurance world is a very confusing place to navigate. The terminology can be almost as foreign as many medical terms. I should know this, when I first began working at Southwest Orthopaedic Physical Therapy, I was a college student with absolutely no idea what health insurance really was. After four years working in this world, I would like to think I have learned a thing or two and I would love to share some things I know. As a medical biller there are a few trends I notice from insurance companies that cost my patients more money than what they expect to pay. I have put together a list of the top five I see on almost a weekly basis. Knowing your insurance plan could save you hundreds or even thousands a year.
1. Your Deductible. Many people lower there insurance premiums by getting a higher deductible. It appears to be a good way to save sometimes significant money every month. The important thing to watch for is what services count towards your deductible. Many times you end up paying so much towards the deductible that it may not save you money in the long end.
2. Prior Authorization. This term may seem confusing for some people that may not be too familiar with insurance. Prior authorization is something you need before you go and see a certain type of medical provider. Depending on your plan, prior authorization may vary but it is important to make sure you know what providers need it because if you have services with out it, you as the patient may be responsible for your services.
3. Caps. Caps are a certain amount of money that you can have as a maximum for visits seen. It is important to know what your cap is for any given provider and if you feel you are close, speak up. If you don't you may be surprised with a pretty big bill.
4. Non Covered Services. Non covered services are those services that your insurance company sees as not necessary for you to receive. A good thing about non covered services is that sometimes you can call your insurance company and they may be willing to pay additional amounts.
5. Participating Providers. Being a participating provider simply means that provider accepts a discount from the insurance company and in doing so, the insurance company lists the providers on their website and also gives the patient less responsibility. It is very important to check your insurance companies’ website or call the medical provider you wish to see to make sure they are participating providers. Not doing so could result in a more patient responsibility.
There are so many things that can bring about a higher out of pocket cost for an individual. These things may or may not apply to your individual plan. The best way to find out is to call your insurance company. They are there to help you feel comfortable getting the medical treatment you deserve. Feel free to ask questions and if you want to learn more subscribe to our blog for more updates.