With the start of a new year, you may have received a new insurance card in the mail. Before you immediately put it your wallet, take a few minutes to ensure all the information is correct and you have an understanding of all the information provided. This will help you in the long run if you run into any issues or have future questions about your healthcare coverage.
- When you receive a new insurance card, verify all the details on the card are correct including your name, policy number, effective date, and any other details. If you find any errors, contact your insurance company immediately to get this card updated and replaced.
- Review the card to understand your coverage like medical, dental and vision
- Keep the card is a safe, accessible place. At your next medical appointment, provide the updated card so the organization can update their records.
There are some basic elements of an insurance card that help you decipher all the information.
Health insurance companies have certain preferred facilities and providers for each plan. In-network and out-of-network benefit descriptions may seem confusing. However, once you understand the difference between the two, you may be able to prevent unexpected healthcare expenses.
The in-network list contains facilities and providers your insurance prefers you use. This means the “in network benefits” as defined by your insurance company, will apply to services you receive at those specific facilities and with those specific providers.
Out-of-Network is the term used to describe non-preferred locations or providers, which your insurance company may not have a contract with. Out-of-network benefits, which generally list a higher expense to you, are applied when you receive services from a non-preferred location or provider. Depending on the type of your insurance plan, you may not have out-of-network benefit options, which could result in charges being denied and then billed directly to you.
Southwest Health takes a wide variety of insurances. You should always check with your insurance company to see if Southwest Health and the provider you wish to see are in-network before scheduling an appointment. You can check by calling the number on the back of your insurance card. This is also important if you switch insurance companies or plans, as the new plan may not have the same preferred facilities and providers as your previous plan.
Insurance terms can be difficult to understand. Here are a few frequently used terms:
- Premium– The amount you or your employer pay for your insurance policy.
- Deductible– The amount you will pay before your health insurance begins covering services. Some services, like preventative services and annual physicals, may be excluded from this.
- Co-payment– This is a flat fee set by your insurance company for each appointment. Some insurance companies also have different co-payment amounts depending on what type of provider you are seeing.
- Co-insurance– After the deductible is applied, the coinsurance is the percentage of the total cost of care you pay. Example: if you have an 80/20 co0insurance plan, your insurance covers 80% of the cost, and you pay 20% of the cost until you meet your Maximum Out of Pocket amount.
- Maximum Out of Pocket- The most you will pay “out of pocket” before the entire amount of your medical bills are paid by your insurance.
If at any time you have questions about insurance, your new card, or coverage, Southwest Health has Patient Financial Counselors who are here to help you. You can reach them by calling 608.342.4717 or emailing pfs@southwesthealth.org.