Shopping for insurance can be one of the simplest experiences a person can have, given the proper tools and knowledge. Health insurance is a hot topic in the news today, often showing how much someone really needs coverage, even for the "what if." With all the different insurance companies, types of coverage and cost can be very confusing, but what you learn by reading this article, you will feel like an expert.
Shopping for insurance can be one of the simplest experiences a person can have,
given the proper tools and knowledge. Health insurance is a hot topic in the news today, often showing how much someone really needs coverage, even for the "what if." With all the different insurance companies, types of coverage and cost can be very confusing, but what you learn by reading this article, you will feel like an expert.
One topic that is very important to people today is the cost of the insurance per month. First and foremost, decide your budget and give a little room for leeway. The next thought is what kind of coverage is necessary should you get hurt or sick. It's not about finding the lowest monthly premium and thinking that is what is best for you, it is about finding the best policy for the amount you want to spend per month.
To view and compare insurance coverage, we hear many different terms, such as copayments, deductibles, coinsurance, out of pocket maximum, within the network and outside network coverage. The terms are the same for all insurance companies, the amounts specified for each policy is different. For starters, the deductible is the amount you pay in advance and out of your pocket before your insurance will pay nothing, the bottom line. The only time you will not have to meet the deductible is when you go to the doctor for a routine visit.
Next you have a copayment, this is the fixed dollar amount you must pay your doctor or office at the time of visit, typically $35. Co-insurance is a percentage you must pay for services, mainly inpatient care, laboratory, and procedures. The percentage you pay with co-insurance is AFTER you have met your deductible amount. The out-of-pocket maximum is the dollar amount you must pay prior to you no longer having to pay co-insurance. In-network and out of network coverage are very similar. When a doctor is contracted with the insurance to provide care and services to you, the doctor is considered "in-network". If a doctor is not on your list of doctors available, and the office said they do not take your insurance, that doctor is considered "out-of-network", in other words, you insurance will not pay for you to see that doctor and you will have to pay for all of it out of your pocket.
An example of this type of coverage, deductible of $ 500, $ 35 co-pay, 20% co-insurance after deductible is met, a maximum of $ 1500 from his pocket, a doctor in the network. The stage, the fall in the arm and is very painful. The states of the doctor's office you can find on the morning after he called night. You appear for the appointment. The wizard asks you to pay the co-payment of $ 35, you kindly pay. The doctor examines him and recommended a radiograph in the office, you consent and the procedure is complete. Determining the arm is broken and needs a cast, everything is finished out of the office.
The assistant now will bill your insurance company. The office visit and treatment is billed at $200, $35 co pay has been applied to the account, and the amount remaining is pending insurance payment. The x-ray is billed at $150, co-pay does not apply to this. After a week, the insurance company has paid their portion. The contracted amount, what the doctor and insurance company agreed for payment, for the office visit and treatment is $135, and the amount remaining must be written off by the doctor. Since the $35 co-pay was paid at the time of service, the insurance company pays the doctor $100, both copay and insurance payment totaling $135, the other $65 is written off, you are not charged for the amount not paid. Now the x-ray payment has appeared.
According to the insurance company, you have already met $480 of your deductible. The insurance company's contracted amount to pay for the x-ray is $105, and writes off $45. You need to meet your deductible of $500. Here is the math behind deductible and co-insurance, $500 deductible - $480 already met = $20 remaining to meet. $105 of x-ray is contracted amount, $105 - $20 = $85. This is where the co-insurance is used, 20% of $85 = $17; $85 -$17 = $68. The insurance company is responsible to pay the doctor $68, and you are responsible to pay the doctor $17 + $20 = $37 for the x-ray. The total amount the doctor was paid by you and the insurance company is $37 + $68 = $105 which is the contracted amount. The plus side to this is, you have now met your deductible, received good care and treatment, and you are on your way to recovery without the full cost of the visit and x-ray!
This is the basic and most important information you need to purchase health insurance, once you know how it works, it is easier to shop and determine your costs
