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Insurance Communication Guide Pt 1

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Kristin Davis

For many people, medical insurance and billing are complicated topics. In fact, studies show that confusion over medical bills as well as higher patient expectations regarding price transparency are increasing in America. That is why today, we are doing our part to help bridge the insurance communication gap by providing insightful information that is aimed to help patients better navigate their healthcare costs. Stay tuned for part 2 next week that will target optimized providers!

Empowered Policy Holders

The single most important thing you can do as a patient is to understand your specific policy. If you don’t know what your cost potentials (deductible, coinsurance, copayment, premium, out of pocket, etc…) are for healthcare services that you may need either currently or in the future (including emergency visits) be sure to contact your insurance company via the phone or online portal (if available) and get well acquainted with those details. You can also reference this article which defines some aforementioned billing terms if you are not already familiar. 

Furthermore, before visiting a healthcare professional, contact the facility where your care will take place and request the CPT code(s) for the service(s) that will be provided that day as well as a price estimate based off of your insurance information. Then, most importantly, once you have the CPT code and price estimate from the provider’s office, you should always call your insurance afterwards with that information to ensure that what you were given was correct and that no other charges are subject to occur.

That being said, estimates are just estimates and they are subject to change once the claims are processed by your insurance company. For example, a common scenario is when a patient may contact the healthcare provider's office and be quoted a coinsurance or copay, but will later be shocked with a larger balance due to a deductible charge that didn't show up when the clinical staff ran the insurance information. 

While this can be due to the facility or provider being out of network with the patient's specific plan, it's important to always double check with your insurance company to make sure they are compliant with your policy. All you need is the National Provider Identifier (NPI) number which you can often look up online or contact the office location directly for. 

Stay Informed

Although this seems like a lot of effort, healthcare billing can be complex, so any time or money you can save by simply educating and empowering yourself as a patient is definitely worth it. If you know exactly how much you should be charged beforehand, it will make it that much easier to spot errors and have them corrected. Check out this article for more tips on reducing payments or disputing medical bills!

Lastly, know that if a service is costly, there are often financing options available you may not be aware of. Be sure to maintain communication with your provider regarding your financial situation and needs. Many healthcare facilities have payment plan options as well as financial assistance programs to help you manage any monetary hurdles that may occur. Beyond that, see what your local community offers in regards to healthcare debt assistance and of course, keep in touch with government legislation that may affect your bills and costs.


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