Know Your Insurance

by Melissa Fredericks


It's Open Enrollment Season!!


This time of year, insurance companies are offering open enrollment. During this time, your employer may change your insurance carrier, or you may choose to change your individual insurance. While we as a healthcare provider cannot recommend a carrier, please keep the following points in mind when choosing your insurance.


*The Network
Make sure that any of your current physicians that you'd like to continue seeing are in the network for the insurance you're considering.


*The Deductible
The deductible is the amount that you must pay EACH YEAR before your insurance will begin covering your expenses. Consider your anticipated health care usage and your finances before choosing a deductible.


*The Co-payment and Co-insurance
A co-payment is the flat fee amount that you pay at the time of service (for example $20). Co-payments are a legal commitment that you make when signing up with an insurance company and they are due at the time of service.


The co-insurance is always a percentage. Once you have paid your deductible, your insurance will begin paying a percentage and you also may have a percentage to pay. For example, some common co-insurance agreements are 80% insurance responsibility, 20% patient responsibility.


*Out of Pocket Maximum
This is the maximum amount that you will pay out of your pocket per policy year. Once you have met your out of pocket maximum, your insurance will cover your services at 100%.


*Policy Exclusions/Riders/Limitations
Many policies have exclusions on certain services or conditions. Please check these in advance to make sure a condition that you have or a service that you receive is not excluded from coverage.


One of the most common misunderstandings that we hear from our patients is when an insurance company states "You are covered for that service". This means the insurance company will cover the condition or service, but all relevant deductibles, co-payments, and co-insurances still apply. Patients often think because it is covered that there will be no out of pocket expense. Be sure to clarify.


Make sure that you have all of the information before you sign up for an insurance. Choose a policy that works best for you and your family. As always, keep all of your providers up to date on your most current insurance coverage so that your claims payments are not delayed. Be sure to bring any new insurance card(s) to your provider's office, as there can be small changes within plans from year to year.



"Dr. Raby is knowledgeable, accessible, caring and extremely competent."
- Raby Institute patient