It's no wonder there are so many billing issues with medical treatments. There are different types of insurance each with their nuances. Below are four common ones:
Health Maintenance Organizations (HMO): With HMOs you pay one amount (maybe $25 or $30) for each doctor visit. You are not billed for anything else and there is no need to submit a claim.
You must use what is called a primary care physician (PCP) who helps you manage your health care. S/he will be the first one you call for any treatment you need. This doctor must be a member of the HMO medical group.
You will need your PCP to provide a referral to see a specialist that also contracts with the HMO.
Preferred Provider Organizations (PPO): With a PPO, you receive the majority of your health care from a provider network like an HMO. But, if you are willing to pay more you can go outside of the network. You can choose to select your primary care doctor from the PPO network.
Health Savings Plans (HSPs): There are two parts you can access with HSA coverage. One is a high-deductible plan and the other is a health savings account. The deductible plan provides basic catastrophic coverage. The HSA operates as a tax-free savings account. You pay for routine medical expenses from this account.
Fee for Service (FFS) or Point of Service (POS) plans: This is a simple plan. You pay for and receive the care you need. Then you are reimbursed for a percentage of the cost.
If selecting from any of these plans, ask the following questions:
• What are the covered health care services?
• What is the yearly premium?
• How are referrals managed?
• How much will it cost for non-network treatment?
• How many in-network doctors are there?
• Where are the network doctors and hospitals located?
• What preventive services are covered?
There are many other factors to consider when you are researching one of these plans.
Deductibles: You will pay a deductible which is part of the insurance coverage that you must pay before the insurance company kicks in their portion. As an example, you might have a family deductible of $5,000 that you will have to satisfy. You insurance company will pay their portion after that.
Copayments: A copayment is an amount you pay at the point of service. You might pay $30 for each doctor's visit but will not be billed for anything else while you are at the doctor's office.
Coinsurance: Coinsurance is expressed as a percentage of the medical bill after you have paid your deductible. For example, if you have a coinsurance rate of 80/20, you will have to pay for 20% of the medical bill while the insurance plan will pay 80%. So, if you have satisfied your deductible and your medical bills over that is $5,000, you will pay $1,000 (20%) and your insurance plan will pay the other $4,000.
Medical billing and claim resolution can get confusing with all of the co-pays, out-of-network providers, deductibles and co-insurance requirements so make sure you understand any medical bills.
Sunni Patterson is an accomplished marketing professional and entrepreneur. She is an expert at developing on and offline marketing strategies.
Health Maintenance Organizations (HMO): With HMOs you pay one amount (maybe $25 or $30) for each doctor visit. You are not billed for anything else and there is no need to submit a claim.
You must use what is called a primary care physician (PCP) who helps you manage your health care. S/he will be the first one you call for any treatment you need. This doctor must be a member of the HMO medical group.
You will need your PCP to provide a referral to see a specialist that also contracts with the HMO.
Preferred Provider Organizations (PPO): With a PPO, you receive the majority of your health care from a provider network like an HMO. But, if you are willing to pay more you can go outside of the network. You can choose to select your primary care doctor from the PPO network.
Health Savings Plans (HSPs): There are two parts you can access with HSA coverage. One is a high-deductible plan and the other is a health savings account. The deductible plan provides basic catastrophic coverage. The HSA operates as a tax-free savings account. You pay for routine medical expenses from this account.
Fee for Service (FFS) or Point of Service (POS) plans: This is a simple plan. You pay for and receive the care you need. Then you are reimbursed for a percentage of the cost.
If selecting from any of these plans, ask the following questions:
• What are the covered health care services?
• What is the yearly premium?
• How are referrals managed?
• How much will it cost for non-network treatment?
• How many in-network doctors are there?
• Where are the network doctors and hospitals located?
• What preventive services are covered?
There are many other factors to consider when you are researching one of these plans.
Deductibles: You will pay a deductible which is part of the insurance coverage that you must pay before the insurance company kicks in their portion. As an example, you might have a family deductible of $5,000 that you will have to satisfy. You insurance company will pay their portion after that.
Copayments: A copayment is an amount you pay at the point of service. You might pay $30 for each doctor's visit but will not be billed for anything else while you are at the doctor's office.
Coinsurance: Coinsurance is expressed as a percentage of the medical bill after you have paid your deductible. For example, if you have a coinsurance rate of 80/20, you will have to pay for 20% of the medical bill while the insurance plan will pay 80%. So, if you have satisfied your deductible and your medical bills over that is $5,000, you will pay $1,000 (20%) and your insurance plan will pay the other $4,000.
Medical billing and claim resolution can get confusing with all of the co-pays, out-of-network providers, deductibles and co-insurance requirements so make sure you understand any medical bills.
Sunni Patterson is an accomplished marketing professional and entrepreneur. She is an expert at developing on and offline marketing strategies.