5 Questions to Ask Your Health Insurance Company Before Going to the Doctor

Understanding your health insurance can help you avoid unnecessary medical bills. Yet, the rules governing your medical benefits and knowing what’s covered can be tricky to navigate. That’s why it’s essential to communicate with your provider before some medical appointments to ensure you get the care you need. Here are a few questions to ask your insurance company to help make informed decisions with your benefits that could save you money. 

How to Avoid Surprise Medical Bills

Private health insurance companies covered 67.3% of the population, while public options accounted for 34.4% in 2018. 27.5 million Americans also didn’t have insurance in 2018, making it critical to promote more awareness around how to use our medical benefits. Some patients will book an appointment only to realize their plan will only pay some or none of their visit. So, how do you know if your upcoming medical visit will be paid in full or subtracted from your deductible? By equipping yourself with the right information ahead of your appointment and asking the following questions.

1. Is My Doctor in My Insurance Company’s Network of Providers? 

Your insurance company and plan decides which health providers, clinics, and hospitals are in-network. Choosing doctors that are in your plan will help you save money on medical costs because your insurance has already negotiated a contracted rate with that provider. Visiting a physician that is not a part of your medical group means your plan will cover less or none of your care, which will result in a higher bill that you will have to pay.

This is why it is necessary to check with your insurance provider and determine which doctors are covered by your plan ahead of an appointment. If you discover your current doctor isn’t in your network, you still might be able to keep him or her as your primary care provider. Check-in with your insurance company and ask about costs for out-of-network specialists to learn more. 

2. Will My Insurance Completely Pay for My Doctor’s Visit?

How much your insurance company covers during a medical visit depends on your in-plan vs. out-of-plan stipulations. The amount your insurance pays out can also depend on the type of appointment, the plan you have, and whether or not you’ve met your deductible. Often annual in-network exams, routine check-ups, and regular screenings will be paid in full or with a copay. Visits to specialists or seeing a doctor to treat an illness might be included only in part. Before making a trip to your health care provider, ask your insurance company to provide a summary of benefits and coverage. This will help you determine how much you may have to pay for your upcoming doctor’s appointment.

3. What Type of Coverage is Most Important for My Family and Me?

Shopping for a health insurance plan is not an easy task. Whether you are looking to make a complete switch to a different company, it’s good to know which options are available. First, figure out the kind of health insurance that works best for you by researching:

• Exclusive provider organization plans (EPOs) 
• Health maintenance organization plans (HMOs)
• Point of Service Plans (POS)
• High Deductible Health Plans (HDHPs)
• Preferred Provider Organization (PPO)

After you’ve chosen your preferred plan type, talk to your health insurance provider and assess the coverage they offer, monthly premium costs, deductible amount, and physician network to make the best decisions for you and your family.

4. What Kind of Care Is and Isn’t Completely Paid by My Insurance?

Health insurance usually covers preventative care, most doctor and hospital visits, and prescriptions, but it’s essential to ask your insurance ahead of time. Elective surgeries, fertility treatments, or brand-new technologies are typically paid for by insurance, but those stipulations aren’t universal for all insurance companies. Since plans vary from person to person, you should always check in with your insurance provider before any surgery, tests, or treatments are performed. This will ensure you have a better understanding of what will be paid by your insurance company and what expenses you will be responsible for paying. 

5. What’s My Deductible and Copayment? 

In order to ask the proper questions about copays and deductibles, it’s essential to understand the differences between the two.

• A deductible is how much you pay out of pocket before your health insurance starts covering all of your medical costs. The amount of your deductible will also affect your monthly premium costs. The lower the deductible, the higher the premium. It’s also important to know that not all medical services will go towards your deductible.
• Copayments are fixed fees that you pay at the time of a health care service. How much you pay varies depending on the type of medical visit. 

Ask your health insurance company what copays you have to pay before using your benefits. Additionally, inquire about what visits, treatments, and surgeries will go towards your deductible before heading to your doctor.

Portland Patient Resources at NWPC

It’s always a good idea to know what insurance plans your care provider accepts before making an appointment. At Northwest Primary Care, we work with all major health insurance companies and can assist you in the referral processes to ensure you are covered. We also accept numerous Medicare Advantage plans, including diagnostic and wellness services. Looking for skilled practitioners covered by your health insurance in Portland? Search our care provider list to find the best doctor included in your medical network!