Understanding Your Health Insurance

UNDERSTANDING YOUR HEALTH INSURANCE

 

Health insurance can be confusing.  As a policy holder and a patient it is important that you understand your insurance plan and coverage.  Health insurance companies have increased policy premiums, increased yearly deductibles, increased co-insurance amounts and increased copays.  A starting point is to understand the differences in these terms.   Premium is the monthly fee for your insurance.  Deductible is how much you pay before your insurer pays.  Co-insurance is the percentage you must pay for your medical care.  Co-pay is your cost due at the time of a medical service.

Today there are many different health insurance companies and each of these companies offer dozens of different health plans with varied coverage and a wide-range of financial responsibility assigned to the patient.  We urge patients to carefully read over their policy and know its specifics.  Some insurances make a distinction between tests ordered for screening purposes (i.e. a patient doesn’t have any symptoms) and a test ordered for diagnostic purposes (i.e. a patient has symptoms).   Some insurance require testing to be done at specific facilities or type of facility (i.e. hospital, clinic or free standing ambulatory center).  It is impossible for our office staff to know the details of every patient’s insurance plan.   If there are any questions regarding coverage for a particular medical procedure or medication it is imperative that patients contact their customer service representative (the telephone number is listed on the back of your insurance card) and ask specific questions.  A good idea is to write down questions before the call and fill in the answers while on the phone. Make sure to note the date of the call and the name of the customer service representative.    If there are coverage issues concerning a scheduled appointment, please contact our office.  Once a service claim has been submitted by this office and processed by an insurance company, resubmittals and/or appeals are difficult, lengthy and in the end may not reverse an initial decision.

Insurance companies vary on coverage for a colonoscopy.  Please follow our colonoscopy insurance information when calling your customer service representative to know your particular benefits.

 

Patients who know their insurance policy are better equipped to make medical care decisions and also know in advance what if any balances will be shifted from the insurance company and billed directly to them.