Health Professionaly Each week health professionals give their educated opinions on relatable health questions. We believe that knowledge is power! Andrew Congdon Doctor of Optometry o OINSIGHT VISION CENTER (715) 732-2101 3003 Cleveland Avenue Marinette, WI uestion: How Does My Insurance Work? : You may have heard many the lower the monthly premium different terms in the news e lately. From Deductibles, to Pre There are many words that are used when talkingabout insurance, and we will try Max Out of Pocket This is a number. enerally larger than your deductible. This miums, to coverage. the amount that you would have to pay even after a deductible is met. If you have a . 90% to 10% plan thatmer is that once you to explain a basic understanding on how the charges until you meet your max out of insurance works ket. The higher the Max Out of Pocket, the Insurance is what you buy as a way to better afford health care costs. When you buy insurance, there are a few factors that go r the monthly premium Co-Pay This is a set amount that you owe your deductible. This can vary if you're visiting your ers insurance, you will be part of a group. Generally, when you are in a group, your primary care doctor or a specialist insurance will cost less due to many people having the same plan which can negotiate a discount People who own their own business, or their job does not offer insu have higher healthcare cost. The following terms wili decide the cost and how the insurance is run Co-Insurance - You may have more than one insurance to cover the cost of your deductibl Many peop called a Seconda Medicare have a second insurance to help with coverage, this is often urance, generally Coverage When an insurance company says something is covered, that doesn't mean it Premium Your premium is your monthly will pay for it. What coverage means, is that cost of the insurance. If you never use your the insurance company recognizes the charge, nsurance. you still have to pay a premium, and the amount will go to your deducible. If The amount that you pay is greatly affected you haven't met your deductible, you have t by other factor the lower the other costs tend to be. If you have multiple people on the same insurance higher the premium, pay the charge. Coverage does not mean your nsurance will pay the charge in your family, your premium will go up. The Prior Authorization- Sometimes your money paid to a premium doesnt go to your insurance will require you to ask for permission ductible, or max out of pocket This can be a tedious task by your doctors office, and may take weeks to months to complete Deductible A deductible is a set amount of money that you have to pay before insurance will start to help you with payments. When you have a bill from a doctor, there will be service charges. If you have not paid enough to reach your deductible, your insurance will not help yo met your deductible, you could still be on the hook for payment if you haven't reached your Insurance can be confusing. The biggest take away is that insurance is not a guarantee for payment. If your insurance company does not u with these charges. Once you have have the doctors office to find out why it hasn't a bill that you thought should be paid, you to contact your insurance company, not max out of pocket. The higher the deductible. paid