Health Insurance (part 1)

 

We are going to veer from my previous posts and start writing about something that I hope can help others. 

PLEASE GET EDUCATED ABOUT YOUR HEALTH INSURANCE! If you are lucky enough to have health insurance through your employer, KNOW your benefits. Everyone should know what Insurance company they have, what their deductible and copays are and if you don't, find out. If you have family members covered, make sure they know as well. I have worked with medical insurance for 30 years now. I have seen changes in the industry many times over. For the past 4-6 years I have said that we have finally hit an era that makes it impossible to predict what the next year will hold in terms of coverage. 

Please understand that this blog is in NO way a political statement. I will let you know my viewpoint from someone who BILLS and collects from health insurance companies and works with patients who are and are not covered. 

I offer a unique point of view in that I am not selling any particular insurance and am not skewed by any kickbacks. 

If you work with an insurance agent to get health coverage, have them show you several plans with benefits and premiums listed. Compare apples to apples.  

We should start with some definitions in layman's terms:

Network:     Many insurance companies belong to a 'network' of doctors and facilities so that they can negotiate what they will pay for services. 

Allowable:  This is the amount that an insurance or network has agreed to pay for a particular service. If you are seeing a physician who is in your insurance network, they cannot bill you for any amounts over the Allowable. 

Deductible:  This is the amount you will pay (Usually each calendar year) before your insurance pays anything. 

Copayment: This is the amount you pay when you receive medical services. 

                    *This can be an office visit copay, a facility (hospital or surgery center) copay, radiology                              copay, laboratory copay, etc. 

                    *Some insurance companies require copayments for EACH service. Eg, if you go to a                                 doctors office and have an xray, you may have two copays.

Coinsurance:  This is the amount you are responsible for after your insurance pays their amount. (This is typically a percentage of the allowable amount.)

I am available for questions or assistance with your particular coverage if you need me. Watch for more blogs with general information and hopefully some key insights into health insurance.