Tuesday, August 14, 2012

Private Insurance-Know Your Benefits!

Insurance can be very confusing, EOB, OOP, CoIns, Stop Loss, AHHHHH!!!!

The best way to get the most out of your private insurance coverage is to know and understand a few bits.

Know your visit limits for therapy.
This is how many visits insurance will cover in one year. If you do not have a secondary insurance like Medicaid, then it is good to know if your child only has 60 visits of physical therapy for the year. Knowing this number can help you work with your therapist so that your child will not have to take a long break at the end of each year when visits run out. If you have visits 2 times per week, come August you would run out of your 60 visits. 

Look for your EOB.
An EOB, or an Explanation of Benefits, should be mailed to you from your insurance provider before you get a bill from a hospital or doctor for a surgery or hospital stay or a test like an MRI or sleep study or EKG, etc.

The EOB will state something like "This is not a bill". This is a paper that simply tells you what was billed to your insurance, how much your insurance paid or discounted and how much you have to pay or "patient responsibility"

If you get a bill for more than what the EOB states you owe, then you need to call the billing department as you only owe what your insurance has agreed on with the hospital.

If you get a bill but have not seen an EOB, call your insurance and make sure that the hospital billed your insurance correctly. Sometimes a hospital may bill you the total amount if they did not get paid from the insurance but maybe the claim got misplaced or the fax machine did not work that day. Don't pay more than you have to.

The more you know and understand about your insurance benefits and coverage, the more you can benefit from your insurance. If you have questions, call your insurance provider and ask.

Christine Grover, PT, MS