Health Insurance Basics

Good Morning ! Hope you are enjoying these sunny,warm, January days. Only 51 days until Spring !
 With health insurance today, it is most important to stay 'in network' to obtain the best coverage from your plan. A few terms to help you understand:

PROVIDER; A physician, (M.D., D.O.) health care professional or health care facility licensed, certified or accredited as required by state law.

PREFERRED PROVIDER: A provider who has a contract with your health insurer (your insurance company)  to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance has a 'tiered' network and you must pay extra to see some providers. Your health insurance may have preferred providers who are also 'participating' providers. Participating providers also contract with your health insurance but the discount may not be as great and you may have to pay more.

NON-PREFERRED PROVIDER: A provider who doesn't have a contract with your health insurer (insurance company) to provide services to you. You will pay more to see a non-preferred provider. 

BALANCE BILLING: When a provider bills you for the difference between the provider's charge and the allowed amount. For example,  if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A PREFERRED PROVIDER may not balance bill you for covered services.

 Until next time ,, sunny skies ..

OMB Control Numbers 1545-2229,1210-0147, and 0938-1146

 

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