Many people do not understand how health insurance works. They are puzzled when the get a bill from a office visit or hospital when they thought they paid their part. Insurance claims can be complicated and many times the doctor has made an error in coding, which can make all the difference in what the insurance company pays.
So you paid your copay when you went to the doctor and now youre wandering why you are getting a bill from that visit. Well if the bill is for lab or x-rays, then that is because typically these procedures are not covered under the copay. Many people do not understand this.
It all comes down to how the visit is coded as well when your doctor send in the claim to your insurance company. An office visit can be coded at 5 different levels and this is what a copay usually covers. Any other code usually falls under the deductible portion of health insurance, which we will discuss later.
Part of this understanding comes from understanding how deductibles and co-insurance works. If you incur charges not covered under a copay, that charge is subject to deductibles and co-insurance. The amount you are responsible for depends on your plan.
If at the time of services you have not meet your deductible then you are responsible for the total charges until you have paid that deductible amount out of pocket for the year. If you used a in network provider or facility you will be charged a negotiated rate.
If your deductible has been meet, but you have co insurance also then you will also be expected to pay a portion of the charges. Lets say you have a 80/20 co insurance. Well then you will have to pay 20% of charges (20% of the negotiated charges if using in network provider) until your co insurance max. has been satisfied.
You need to know if your insurance company goes by calendar year or anniversary date. This makes a huge difference and is reason for much confusion for many. If they go by calendar year then no matter your time of policy purchase everything (deductible and co insurance ) will start over on January 1st.
If you have a preventative benefit it is important to understand its limits. It likely has a maximum payout and will only cover certain procedures. If you think you need a preventative exam because you have been feeling a little off, then do not schedule as a preventative exam, this code will be rejected if used twice in one year.
So you paid your copay when you went to the doctor and now youre wandering why you are getting a bill from that visit. Well if the bill is for lab or x-rays, then that is because typically these procedures are not covered under the copay. Many people do not understand this.
It all comes down to how the visit is coded as well when your doctor send in the claim to your insurance company. An office visit can be coded at 5 different levels and this is what a copay usually covers. Any other code usually falls under the deductible portion of health insurance, which we will discuss later.
Part of this understanding comes from understanding how deductibles and co-insurance works. If you incur charges not covered under a copay, that charge is subject to deductibles and co-insurance. The amount you are responsible for depends on your plan.
If at the time of services you have not meet your deductible then you are responsible for the total charges until you have paid that deductible amount out of pocket for the year. If you used a in network provider or facility you will be charged a negotiated rate.
If your deductible has been meet, but you have co insurance also then you will also be expected to pay a portion of the charges. Lets say you have a 80/20 co insurance. Well then you will have to pay 20% of charges (20% of the negotiated charges if using in network provider) until your co insurance max. has been satisfied.
You need to know if your insurance company goes by calendar year or anniversary date. This makes a huge difference and is reason for much confusion for many. If they go by calendar year then no matter your time of policy purchase everything (deductible and co insurance ) will start over on January 1st.
If you have a preventative benefit it is important to understand its limits. It likely has a maximum payout and will only cover certain procedures. If you think you need a preventative exam because you have been feeling a little off, then do not schedule as a preventative exam, this code will be rejected if used twice in one year.
About the Author:
Agent Jeff Cline is dedicated to helping individuals finding health insurance that fits their needs and their budget. He is a leader in Tx Health Insurance as well as most other States. Have Jeff Cline be your direct link to affordable insurance of any kind. Contact him anyday, anytime toll free at (866)526-9669.
No comments:
Post a Comment