A guide to finding your way through the insurance maze.
You need surgery. Where can you go and what will it cost?
Finding
your way through your insurance benefits can be complicated. Health
insurance and medical care are major investments -- ones you're already
paying for and often don't have much choice about. But here's your
chance to do something about the expense.
You may have more
choices than you think and your choice may make a big difference in
what you pay. Nowadays, it's up to you. That's good, because you can
save yourself and your employer some money. But that's difficult,
because now you need to figure out what to do.
This page is
designed to help walk you through the process of choosing who your
surgeon will be, where you will go for your surgery and figuring out
what it will cost you and your employer's insurance company.
Download our calculator to help you gather this information. Then, contact us so we can
help you check your data and provide you with a quote for your
procedure.
First you need to understand a couple important insurance terms.
Don't be discouraged. You will see how important these terms shortly.
Deductible:
the amount of money you must pay each year before your health insurance
plan starts to pay for covered medical expenses. For example, if your
bill is $5000 and your deductible is $1000, you pay the first $1000 out
of your pocket. Then your insurance carrier will consider paying the
remaining $4000, based on the terms of your plan.
Coinsurance:
the cost-sharing part of your plan where you are responsible for paying
a certain percentage and the insurance company will pay the remaining
percentage of the covered medical expenses after your deductible is
met. If your health insurance plan pays 20% coinsurance, once your
deductible is met, your insurance company will pay 80% of the covered
expenses while you pay the remaining 20%. Following the same example
for a $5000 expense, you would pay the $1000 deductible, then 20% of
the $4000 remaining or $1800; finally, your insurance carrier would pay
$3200 if the charges are allowable in your plan.
Out-of-pocket limit:
the maximum amount you will pay out of your own pocket for covered
medical expenses in a given year. When your expenses have met the
out-of-pocket limit, any further expenses you incur that plan year will
be covered 100%. You'll need to check with your insurance carrier to
see if your deductible counts toward satisfying the out-of-pocket
maximum.
In-network providers and facilities: have
entered into a contract with your insurance company. The reimbursement
they receive from your insurance company for providing you services is
pre-negotiated, called a "contract allowable" rate for specific medical
services. Your out-of-pocket (deductible, coinsurance, co-pay, etc.)
will be calculated based on this "contract allowable" rate.
Your surgery ... components It's
not a "package deal." You'll be dealing with bills from several
sources. Trying to figure out what it will cost means you'll have to
tally up several estimates.
In most cases, here's who will be billing you:
1.
The surgeon generally has a standard fee for your procedure which will
also include your pre-operative office visit and any necessary
post-operative visits.
2. The surgical facility generally has a standard fee for your procedure.
3. Anesthesiologyis
generally under contract with the surgical facility, so you may not
have a choice with this provider. The surgical facility may provide you
with this cost; otherwise you'll need to contact them yourself.
4.
Depending on your procedure, your physician may order laboratory tests
or radiology (x-rays). Typically, you can have these done anywhere and
cost differences can be substantial.
