Ask a Health Professional Each week health professionals give their educated opinions on relat- able health questions. We believe that knowledge is power! INSIGHT VICWRTER Andrew Congdon OD. Doctor of Optometry 0:0 (715) 732-2101 OINSIGHT VISION CENTER 3003 Cleveland Avenue Marinette, WI Question: How Does My Insurance Work? You may have heard many different terms in the news lately. From Deductibles, to Premiums, to coverage. There are many words that are used when talking about insurance, and we will try to explain a basic understanding on how the lower the monthly premium. A: Max Out of Pocket - This is a number, generally larger than your deductible. This is the amount that you would have to pay even after a deductible is met. If you have a go% to 10% plan, that means that once your deductible is met, you still have to pay 10% of the charges until you meet your max out of pocket. The higher the Max Out of Pocket, the lower the monthly premium. insurance works. 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 into the price of that insurance. If your job offers insurance, you will be part of a group. Generally, when you are in a group, your 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 insurance, generally have higher healthcare cost. The following terms will decide the cost and how the insurance is run. Co-Pay - This is a set amount that you owe for every visit. This does not go towards your deductible. This can vary if you're visiting your primary care doctor or a specialist, Co-Insurance - You may have more than one insurance to cover the cost of your deductible. Many people on Medicare have a second insurance to help with coverage, this is often called a Secondary. Coverage - When an insurance company says something is covered, that doesn't mean it will pay for it What coverage means, is that the insurance company recognizes the charge, and the amount will go to your deducible. If you haven't met your deductible, you have to pay the charge. Coverage does not mean your insurance will pay the charge Premium cost of the insurance. If you never use your insurance, you still have to pay a premium, The amount that you pay is greatly affected by other factors, The higher the premium, the lower the other costs tend to be. If you have multiple people on the same insurance in your family, your premium will go up. The money paid to a premium doesn't go to your deductible, or max out of pocket. Your premium is your monthly Prior Authorization Sometimes your insurance will require you to ask for permission before getting certain tests or drugs covered. This can be a tedious task by your doctor's 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 wil not help you with these charges. Once you have met your deductible, you could still be on the hook for payment if you haven't reached your max out of pocket. The higher the deductible, Insurance can be confusing. The biggest take away is that insurance is not a guarantee for payment. It your insurance company does not pay a bill that you thought should be paid, you have to contact your insurance company, not the doctor's office to find out why it hasn't been paid. Ask a Health Professional Each week health professionals give their educated opinions on relat- able health questions. We believe that knowledge is power! INSIGHT VICWRTER Andrew Congdon OD. Doctor of Optometry 0:0 (715) 732-2101 OINSIGHT VISION CENTER 3003 Cleveland Avenue Marinette, WI Question: How Does My Insurance Work? You may have heard many different terms in the news lately. From Deductibles, to Premiums, to coverage. There are many words that are used when talking about insurance, and we will try to explain a basic understanding on how the lower the monthly premium. A: Max Out of Pocket - This is a number, generally larger than your deductible. This is the amount that you would have to pay even after a deductible is met. If you have a go% to 10% plan, that means that once your deductible is met, you still have to pay 10% of the charges until you meet your max out of pocket. The higher the Max Out of Pocket, the lower the monthly premium. insurance works. 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 into the price of that insurance. If your job offers insurance, you will be part of a group. Generally, when you are in a group, your 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 insurance, generally have higher healthcare cost. The following terms will decide the cost and how the insurance is run. Co-Pay - This is a set amount that you owe for every visit. This does not go towards your deductible. This can vary if you're visiting your primary care doctor or a specialist, Co-Insurance - You may have more than one insurance to cover the cost of your deductible. Many people on Medicare have a second insurance to help with coverage, this is often called a Secondary. Coverage - When an insurance company says something is covered, that doesn't mean it will pay for it What coverage means, is that the insurance company recognizes the charge, and the amount will go to your deducible. If you haven't met your deductible, you have to pay the charge. Coverage does not mean your insurance will pay the charge Premium cost of the insurance. If you never use your insurance, you still have to pay a premium, The amount that you pay is greatly affected by other factors, The higher the premium, the lower the other costs tend to be. If you have multiple people on the same insurance in your family, your premium will go up. The money paid to a premium doesn't go to your deductible, or max out of pocket. Your premium is your monthly Prior Authorization Sometimes your insurance will require you to ask for permission before getting certain tests or drugs covered. This can be a tedious task by your doctor's 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 wil not help you with these charges. Once you have met your deductible, you could still be on the hook for payment if you haven't reached your max out of pocket. The higher the deductible, Insurance can be confusing. The biggest take away is that insurance is not a guarantee for payment. It your insurance company does not pay a bill that you thought should be paid, you have to contact your insurance company, not the doctor's office to find out why it hasn't been paid.