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Understanding Health Insurance

 

​​​​Health insurance, with all its provisions, provider networks and co-pays, can leave anyone dazed and confused, but it doesn't have to be that way. Here are some tips to help make navigating your insurance coverage a bit easier.

1)      Know Your Insurance Plan

  • Make sure that you understand your insurance plan including the provider network, what services are covered and any deductibles and co-pays that may be required.
  • Check to ensure your provider is within your network. Using out-of-network providers can result in higher out-of-pocket expenses.
  • Some insurance plans use a tiered system. For the highest level of payable benefits, always select a Tier 1 provider.
  • If you have questions, refer to the back of your insurance card. Important phone numbers, benefit websites and addresses are all listed as an easy reference of where to go with your questions. 

2)      Don't Worry About Your Location

  • Your insurance coverage is not affected by your location. Your insurance goes with you wherever you seek services. Some employers choose to keep the network of providers available to their employees local, but even so, everyone is still covered by insurance, even when they're out of town and require the services of an out-of-network provider. It is important to note, however, that patient out-of-pocket expenses could be increased.
  • If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility while out of town, you will only be billed at the in-network provider rates for co-pays and coinsurance.  For example, if you are on vacation and land in the emergency room with a broken bone, you will not be charged anything additional, even though you were seen by an out-of-network facility and provider.

3)      Be Your Own Best Advocate

  • Ask questions. If you don't understand if a service is covered or are confused about a medical bill you received, call your provider, or check with your insurance company. 
  • Find out about the costs in advance. Thanks to laws requiring more transparency in medical pricing, you can even get an estimate of the costs pr​ior to a procedure. Visit the Boys Town National Research Hospital "For Patients"​ tab to access the cost estimate tool.  

​Navigating the world of health insurance coverage can be confusing, so when in doubt about whether a procedure is covered or a provider is in network, contact your insurance company and get the answers you need prior to seeking medical care.

Important Terms

  • Co-pay: the specific dollar amount you pay at the time medical care is received
  • Deductible: the specific dollar amount of the medical expenses that you must pay before your insurance company begins to cover the remaining costs
  • Out-of-pocket expenses: the payments you make for healthcare services that will not be reimbursed by your insurance company
  • Provider network: a formal affiliation of healthcare providers contracted with your insurance company from whom you can choose to seek medical services
  • Provision: any contingencies that are outlined in your insurance policy​
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