Benefits booklets are dry reading, I know--there’s a reason benefits
booklets aren’t at the top of any bestseller lists. But it is important for you
to have an idea of what your plan covers so you don’t get caught short when you
have a health crisis. If you don’t understand the benefits booklet, call the
insurance company’s customer service—they should be able to explain anything
you don’t understand. You should review your benefits booklet when:
You first sign up for
coverage
When you have a new health
problem
When they send you updates to
your health plan
Make Certain your Provider Charges only what You Owe
Doctors who participate in your insurance plan have signed an agreement that
they will not charge you for more than what the insurance company says they can.
If you have:
HMO (health maintenance
organization)
PPO (Preferred Provider
Organization)
POS (point-of-service) plan,
you will probably be expected to pay a set amount (called a co-pay) for each
visit. With an indemnity (also called “traditional”) or a traditional Medicare
plan, you will pay 100% out-of-pocket until you reach your deductible. If the
doctor’s office tries to collect the total charged amount from you up front,
ask them to call your insurance company and find out how much of your deductible
you’ve met and what the “allowed amount” is. If the doctor’s original fee is
$200, the insurance company may allow them to bill for only $120. And if you’ve
met your out-of-pocket, they can’t charge you anything up front.
Why is this information important? Many doctors’ offices have a policy of
not returning your credit unless you ask for it, and they can hang onto your
money for years, until they finally clear their old accounts.