When it comes to dealing with insurance companies, you are more often than not, left feeling frustrated, overwhelmed, discouraged and even more confused than when you started. In order to get the most out of your benefits and not get hit with any aggravating surprises, you have to get a little insurance savvy. Before you give up, there are a few simple questions you can ask so that you know what you are entitled to and what you might be getting yourself into.
Although getting your basic coverage straight can be overwhelming, believe it or not, it can get even more complicated- But in a good way. It is clear that integrative, holistic and naturopathic approaches to health and wellness are gaining momentum. So much so that some insurance companies are recognizing the importance of the body’s innate ability to heal itself and are actually covering a limited amount of alternative therapies such as nutrition counseling, chiropractic, massage therapy, acupuncture, homeopathy, mind-body stress management, yoga therapy and meditation. Through your insurance company, you may even be eligible for membership at a local health club or be able to attend valuable health related seminars and lectures so that you can Move toward becoming an expert on your own mental, physical and spiritual health.
It is important that you take control of your own health and be your own advocate. Contact your insurance provider before you receive any kind of medical service or alternative therapy and make sure to ask these key questions:
Does this care need to be pre-authorized or pre-approved?
Coverage for certain types of care is not covered by your insurance company unless pre-approved. Inconvenient? Probably so. Insurance companies require pre-approval in order to confirm medical necessity. This helps insurance companies control health care costs by minimizing duplication of services and/or avoiding unnecessary treatments, visits or services.
Can you provide me with a list of In-Network practitioners in my area?
Your insurance company can provide you with a list of In-Network practitioners. In-Network providers have agreed to accept your plan’s contracted rate as payment in full for services. Your share may be in the form of a co-pay or deductible for In-Network providers. Providers that are Out-of-Network have not agreed to any set rate and may charge more for services and your plan may call for higher co-pays or deductibles for out-of-network services. Out-of-Network care may not be covered at all by your insurance company.
Are there any services that have been outsourced to another insurance company?
More recently, insurance companies have begun outsourcing certain services to other insurance companies. So, while you think your mental health and other services are covered by your insurance plan and the company you elected, these services may be covered under a completely different insurance company all together. And if the provider you happen to see is not in network with this unknown insurance company, you could get hit with a big bill. Though its likely in the fine print somewhere, most members don’t even know that this is the case for their own individual plan and never even receive an insurance card or policy number for the secondary insurance company. So-When you are speaking with your insurance company about coverage, make sure you ask directly about coverage for specific services. You can even ask your provider for billing and procedure codes before scheduling your appointment, just to be sure.
If I use a practitioner who is not part of your network, do you provide any coverage?
Sometimes, insurance companies will reimburse a portion or full cost of a visit, treatment, or service when provided an invoice. Insurance companies may pay a portion or percentage of out of net work provider fees or reimburse a member for “fee for service” providers.
Do I have a deductible, if so, what is my deductible?
A deductible is the amount a member must pay before benefits kick in and services are covered by insurance. The deductible is not always applicable to all services. Some services or visits may be covered without patients having to pay into their deductible first.
After my deductible is met, what percentage of care is covered for this particular service?
Some insurance companies will only pay a percentage of the cost of services even after a deductible is met. It is important to ask what percentage will be covered by your insurance company and for what you will be responsible. If you are interested in finding out exactly how much you will owe after a service, visit or procedure is complete, prior to service, you can ask the provider what code they use to bill a particular service and check with your insurance company about coverage regarding that particular billing code.
Do I have a co-pay?
A co-pay is the amount owed by the patient at the time of service. You will be responsible for your co-pay at the beginning or end of each appointment. The co-pay amount generally does not count toward a member’s deductible.
How many visits are covered and over what period of time?
Some insurance companies only cover a certain amount of visits per calendar year. For instance, a member’s plan may only cover 15 counseling or psychotherapy visits per calendar year and any visits after that limit is met will be the responsibility of the member.
Does my plan include a health and wellness program?
Some insurance companies have a health and wellness program that cover a limited amount of alternative therapies such as nutrition counseling, chiropractic, massage therapy, acupuncture, homeopathy, mind-body stress management, yoga therapy and meditation. In addition, you may even be eligible for membership at a local health club or be able to attend valuable health related seminars and lectures.