Medical Insurance - Understanding your Benefits
Medical insurance has become more complicated and many patients are experiencing higher deductibles and co-payments.
In addition, insurance collections have gotten more complicated for medical providers. Medical offices are now often required to collect your deductible or copayment before receiving any insurance payments, and sometimes your deductible is the only payment your doctor receives for their services. Many insurance carriers are also requiring written referrals/preauthorization from your primary doctor.
In order to continue providing care to the community, our office now requires surgery deposits for most commercial insurance members and full payment of your deductible or coinsurance amount PRIOR to your surgery. If a referral/preauthorization is required, you must be your own advocate to insure that you are eligible to receive insurance benefits/payments.
Why does it cost so much?
The cost of surgery includes the care your surgeon provides (usually 10% or less of the total amount) plus additional charges from other care providers (anesthesiologist, pathologist, surgical assistant, etc.), lab and radiology testing, hospital expenses, and nursing care.
What is a “deductible”?
A deductible is “the amount of expenses that must be paid out of pocket before an insurer will pay any expenses” (ref: Wikipedia).
What is a "co-payment"?
A co-payment is a set amount that you are required to pay when you receive certain types of medical services. This may or may not be applied toward your deductible, depending on your insurance policy.
What is "co-insurance"?
Co-insurance is “a percentage that the insurer pays after the insurance policy’s deductible is exceeded” (ref: Wikipedia). Depending on your plan, you may be responsible for additional costs beyond your deductible. Generally, most plans have an “out-of-pocket maximum” amount that you may be responsible for. Given the expense of surgery, most patients do end up being responsible for their full “out-of-pocket maximum”.
What payments count towards my “deductible” and “out-of-pocket maximum”?
This depends on your insurance – call your insurance company or read through your policy to see what payments count towards your portion of the costs.