Get to Know Your Insurance Payer

It is a person's own responsibility to understand their insurance policies, benefits, and responsibilities. The purpose of this resource is to provide support while you work to gaining a better understanding of your insurance. Our goal of providing this information below is for you to feel fully informed and confident

 Below are important questions, helpful definitions, and possible resources that may be helpful.

1.      It’s important to understand and have an overview of what’s covered. Also having an explanation of what’s not covered and/or the limits on coverage.

2.      It is important to understand the possible costs you might have to pay - like deductibles, coinsurance, and copayments. When you receive care, you and your health insurance usually each pay some of the cost. This is called cost-sharing. How the cost is divided is determined by your benefits, as outlined in your coverage document. Deductibles, copayments, and coinsurance are all examples of cost-sharing and describe an amount that may apply when you receive care.

3.      Make yourself aware of where to go online to review and print copies of complete health plan documents.

4.      Most of the time the contact number to call with questions is on the back on your insurance card or available on the insurance companies’ website.

5.      Many people have more than one insurance. It’s important for you to know what insurance payer primary and which insurance payer is secondary 

6.      Be aware of when you renew your health plan, changes happen within your health plan, and/or make a change or are added to a health plan – for example, if you get married or have a child. Things change and important to check in when seeking new treatment.

Important terms and phrases understand:

Premium = The financial amount that a patient has to pay in order to gain access to a health insurance plan.

Deductible = The price that people pay for access to health care services before their insurance plans start to cover any cost. If a person chooses to pay a higher deductible, this generally means a lower premium.

Copay = The amount that a patient has to pay upfront for a healthcare-related service or treatment. The rest of these expenses are usually covered by their insurance plan.

Coinsurance = The percentage of any medical bill that patients must pay, due to hospitalizations or similar treatments, after their deductible has been met.

Provider = Any healthcare professional or institution.

In-network = A situation where the healthcare provider has made a deal with a patient’s insurance plan to accept a set amount of money for specific treatments. The provider is not allowed to charge patients more than this set amount.

Out-of-network = A situation where the healthcare provider has not made a deal with an insurance plan. In this case, the provider can bill a patient directly for the financial amount that they believe their services are worth.

POS (Point of Service) = A type of insurance plan where patients pay less if they use doctors, hospitals and other healthcare providers that belong to the plan’s network. POS insurance plans require patients to get a referral from their primary care provider in order to see a specialist.

One last resource that may be helpful:

Article: 8 Definitions To Help You Make Sense Of Your Insurance Policy
Link: https://www.buzzfeed.com/healthmarkets/definitions-to-help-you-make-sense-of-your-insuran