Time is Money: How to Decode Your Medical Coverage Plan

by Darwin on October 27, 2016

It is important to learn what is covered in your medical plan and what isn’t. The last thing anyone wants is getting surprised by a medical expense because they didn’t know the full extent of their plan. There are common mistakes referred to as surprise medical billing where someone uses an out-of-network doctor not covered in your insurance, which then makes you face a large bill. Let’s look at coverage options and go into the details of this situation.


Common Insurance Situation


Many times this situation will occur when patients are at a hospital in their provider network and then go to a doctor who is non-networked into that plan. Health insurance plans will cover charges on their base percentage amount except for when it comes to out of network doctors that may treat you. The difference in what you have to pay could be thousands of dollars depending on length of stay or what kind of treatment it was.


On top of this any over billed amount that you have won’t be covered by your health insurance’s deductible making things more complicated.  The problem here is that patients aren’t going to research every doctor at a hospital, especially in the case of an emergency situation. Some states have legislated against state billing through numerous health insurance reforms. For the most part, states have yet to protect consumers from being charged out of network prices.


Loans to Cover Expenses


If in the event this happens to you and the overcharge is minimal and can’t be brought down through speaking with your insurer or hospital, it must be paid. One of the best ways to do that is to get the payment on an installment. The method behind this would be using something like a King Kash Loan.  Taking out this loan is easy, can be done online or through the phone and there is quick delivery of cash.


They offer personal loans on 12-month terms with fixed monthly payments. You can secure anywhere from $100 to $3000 to cover any unintended charges for your medical bill.  As many states don’t protect consumers, it is up to you to learn what a provider network is in the first place so you don’t get a surprise bill.


Provider Network Details


A provider network is a group of different health care providers, which includes hospitals and clinics along with doctors that have contracts with your individual health insurance company. Contracts between doctors and insurers have the possibility to not include all of your company’s policies, only a few. Facilities and doctors are included in this network. Different types of care costs like tests are covered differently in each individual personal policy.

Another part of the contract between insurers and providers is payment rates. These rates help patients shop for medical services that are covered by their individual insurance. These types of rate agreements are not the same for people outside of the network, as the insurance company cannot influence what the provider is going to charge.


In some insurance plans they will cover a small part of your medical bill if you go outside of a network. Other insurance companies will be none of the plan unless in the case of an emergency. If they do pay a small amount, consumers are more likely to go with this plan so they can see an out of network doctor.


Comparing the Difference


Oftentimes if you’re aware of the difference and see a out of network doctor on a regular basis, you’ll want to stick with your doctor because you like them and trust them. Types of insurance plans that are generous and cover that include PPO or POS insurance plans. They’ll usually pay half of what you owe in doctors’ fees while you have to pay the difference.


When this is not the case and you have to pay for your own coverage, the differences can really add up on how much money you didn’t save and have to pay instead.  The best way to avoid these charges is to check beforehand going to the doctors or hospital. If you’re going to see a new doctor for an X-ray or blood test, check each time on your insurance plan. These can be accessed through a directory on your insurer’s physician list. Verify that everything has gone through all right before booking your next visit and you’ll avoid the hassle all together by staying in network.


Sebastian Barton writes about personal finance and how to prepare for the unexpected. He is a Father with two pre-teen kids and learned how to handle his finances when he was made redundant several years ag

{ 1 comment… read it below or add one }

Money Beagle October 28, 2016 at 12:42 pm

Open enrollment for us is right around the corner. We usually get our choices and such sent out in early November so I expect we’ll see something next week.


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