Insurance Part II

In our last blog, “Insurance Part I” we went over if your insurance covers Chiropractic or Massage, copay and coinsurance, and your deductible. Here are a few more terms that you may have heard about hopefully explained in a way that you will understand it with your insurance plan to help you make good medical decisions.

What is a Pre-Authorization?

You may get mail from your insurance company letting you know of a certain number of authorized visits within a duration of time for a service. But you checked and isn’t that service already covered? What insurance companies will do, is say “yes, you can  have ____ care”, but then every time you want or need to go, they require someone from that office to ask for a authorization for that visit. Then you and the service provider will receive an approval or denial for services for the dates requested and how many more visits that authorization will cover. It is a little tedious at times, but you shouldn’t worry about it too much, normally the office will take care of that for you, and patient health and treatment always comes first for us!

What is my Out of Pocket Maximum?

The out-of-pocket maximum is the most that you have to pay for covered services in a plan year. After you have paid this amount on deductibles, copayments, and coinsurance, your insurance will pay 100% of the covered services. You no longer will pay for the remainder of the plan year.

In-Network

In-Network providers or medical establishments offer patient services that are best covered by your insurance. They are normally cheaper than out-of-network and have a contract with your insurance in which they have negotiated a better rate for you.

Out-of-Network

Out-of-network are providers or medical establishments that are not contracted with or covered by your insurance plan. These services can end up being more expensive for patient cost. Check with your plan to see what they will cover out-of-network, you may end up paying their normal rate, or your insurance would just cover less than they would for an in-network provider.