WHAT TO KNOW: KEEPING THE SUPRISES TO A MINIMUM

Nobody can tell you how much your visit will cost until after you have seen the doctor.  However, knowing the following information will make it a more pleasant experience for you and your doctors office.

YOUR RESPONSIBILITY:

Be Proactive. You are responsible for your bill and knowing your coverage, It is recommended that you keep in contact with your doctor’s office and your insurance company to ensure timely payment of claims. If all entity’s work together, it normally will take less time to resolve any issues.

YOUR COPAY AND YOUR DEDUCTIBLE:

This will assist you in paying the correct amount at time of service.  If you do not know this information it can cause some confusion and you may be asked to pay for your visit in full.  Most doctors offices will bill insurance as a courtesy, and therefore the more accurate information they have, the more accurate your bill will be.

YOUR PREFERRED LAB:

If you have a preferred lab, it is important to know this information before you see the doctor, so he can help ensure you are going to the correct place.  Doctors do not know your plan.  If you need to go to a certain lab let him know.  If there is a lab in your doctors building it does not mean it is preferred by your plan.

YOUR PREFERRED HOSPITAL:

This is important to know because if it is determined you are in need of hospitalization while you are in with the doctor he/she will know where to send you.

Helpful Definitions:

Non Preferred Provider (Non PPO):  A provider that is not contracted with an insurance company and therefore will not make any adjustments to the fee as dictated by an insurance company.

Preferred Provider (PPO):  A provider that has a contract with an insurance company, and therefore will take adjustments to the patients account giving them a special rate. If you choose to go to a non preferred physician you will not get the special rates offered by a preferred physician.

Preferred Laboratory:  A preferred laboratory is a lab that has a contract with your insurance carrier or plan to ensure you get a special rate. If you choose to go to a non preferred lab you will not get the special rates offered by a preferred lab.

Preferred Hospital:  A hospital that has a contract with your insurance carrier or plan to ensure you get a special rate. If you choose to go to a non preferred hospital you will not get the special rates offered by a preferred hospital.

Carrier:  Any insurance company backed by the insurance commission.  Your insurance card should state “insurance company” somewhere on the card.

Plan:  The special deal you have selected from your insurance carrier.  There are many different insurances, and many different plans within each insurance company.  There is no way for your doctors office to know all the different plans.

Copay:  The amount of the bill a patient is liable for as agreed upon with their insurance company.  This can be a percentage or a flat fee amount.

Deductible:  A yearly amount set by the insurance company, dictated by plan you have signed up with through your insurance company.

Out of Pocket:  The amount of money according to your plan you will have to pay before your insurance company pays at 100%. (This varies from carrier and plan.)

Usual and Customary or UCR (allowed amount):  Every insurance company decides what they feel is a usual and customary fee. This is not the same for all insurances.  Doctors must bill the same amount to every insurance company.  If the doctors office is contracted with an insurance carrier the savings a patient receives is the difference between the charged amount and the “allowed amount”

Pre-authorization:  Some insurance plans need to know before certain procedures are done.  This may include MRI’s, CAT Scans, and Hospital stays.