Did you make a trip to the hospital? Do you have a ton of bills and you don’t know why since you have insurance? You are not alone! There are a lot of adults in the United States that don’t understand insurance. Health insurance may be hard to understand, at first. The Henry J. Kaiser Family foundation tested men and women in basic health insurance information and the results are shocking. Fifty percent of females and forty-seven percent of men failed the ten question test on basic health insurance information with scores under seventy percent. That is shocking! Here are some helpful terms that may confuse people.
Some helpful health insurance terms to get yours through this policy year and the next!
- Premiums are the amounts you pay monthly to stay covered.
- Deductibles are the amount you have to pay before your insurance pays anything. (Hint: Check to see if your deductible payment goes toward your out-of-pocket.)
- Out-of-pocket is the amount you need to pay to assist the insurance. (Hint: Once you pay all of your deductibles and out-of-pocket most procedures are free!)
- Co-pay is what you pay upfront to assist the insurance. (Hint: Check your plans to see if this goes toward the deductible, out-of-pocket, both, or neither!)
- Coinsurance is the percentage that you assist the insurance to pay when the doctor’s office charges you. (Hint: The doctor’s office can ask for payment when they see fit. This has nothing to do with your insurance company.)
- In Network is the doctors, labs, and hospitals that have a contract with the insurance and your plan; to bring you better deals. (Hint: Never go by your friends In Network status is.)
- Out of Network is the doctors, labs, and hospitals that do not have a contract with your insurance or plan. This means no deals and it could get expensive very fast! (Hint: Even if the hospital or doctor is In Network the labs and other doctors maybe Out of Network. Always check with your insurance)
- Procedure codes are codes that the doctor’s office or hospital use to bill the insurance company. (Hint: Talk to the medical billing and coding specialist after the doctor makes the order to receive the procedure codes.)
- Prior authorizations give the insurance company the opportunity to check if a procedure will be covered under your plan before the procedure happens. (Hint: You can appeal a denial decision if you feel that the plan does cover it.)
Health insurance is not that difficult! Ask your insurance company questions we are here to help. The only questions that are crazy are the ones that are never asked! You can contact us with any questions concerning your plan or future plan. We are here to help you.