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Wednesday, July 22, 2015

The way insurance works, it is set up to have you pay your own medical care out of pocket up to a certain dollar limit. 

This is called the deductible, and the level of that number often has a large effect on the total cost of your health care package. Insurance is rarely as simple as a deductible number, however, and understanding all of the language in your bill can keep you from being surprised when more bills than you expect come due after a major medical procedure. Working with insurance companies can be time consuming, and it is always best to understand things ahead of time to save you hassle. Here are five things that can make a big impact to your medical bills outside of your deductible.

When Deductible Ends, Co-Insurance Continues

If the cost of something is just a little bit more than the deductible, the co-insurance may be used to pay some of it. In this case, you are responsible for a certain portion of the medical bill. This is often between twenty and fifty percent, and may or may not have a maximum point where insurance will cover the rest of the bills after this. Often, maximum's are set in-network but excluded out of network.

In the Network vs. Out of Network

Choosing health care providers who are in your insurance company's network is important if you want the maximum savings on your behalf. You are always free to choose others, but know that this often means paying a high co-insurance rate. You can often find a list of providers on your insurance company's website that you can work with. Occasionally, smaller providers may be willing to become a part of your insurance company's network to keep your business if you discuss it with them.


Some Exceptions to Out of Network Exist

If you or your child needs a certain procedure that has been deemed medically necessary, and experts in this field are not available, you may be able to use an out-of-network provider at in-network rates. This is most commonly done with very specialized care. Rare diseases and pediatric surgeries at facilities out of the area may be required to provide the best chance for you and your family. In these cases, working with your insurance company to provide an insurance exception ahead of time is the best way to go.

Not Everything is Covered that You Think

If you have a year with enough medical procedures to result in a fully paid deductible, you may be tempted to take the rest of the year and get everything done that you want, free of charge. Pending your coverage during something like a pregnancy, your appointments with a maternal specialist, like Dr. Gilbert Webb, could be completely covered. Though this might be a good year to cover other medical surgeries that will be required soon, others may still be excluded, particularly things considered medically unnecessary. IVF surgeries, cosmetic surgeries and things of the sort will still be excluded in most cases. Other things like Lasik surgery may, however, be a good thing to do in a year like this.

Claim Denial isn't the End

If you find that you're still paying more than you believed that you should for a procedure or series of medical appointments, you may have been denied. There is a claim appeal process for denials that may be unfair or against the rules. Keep records of all discussions with insurance personnel with names and dates, and work with your doctors on showing how things are medically necessary. In some cases, like mental health treatment, the insurance companies may not have yet caught up with the new laws concerning what is required to be treated vs. excluded. If you feel you're over your head, you can work with a company who specializes in recovering lost medical claims.

As you can see, there is a lot more to a medical bill than the deductible. Knowing as much as you can going into any major hospital bills can help you to navigate this in the way that is the most financially beneficial to you. 


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