Health Insurance Confusion

I am very excited to announce that I have recently been credentialed with Blue Cross Blue Shield of Texas and Humana. So as an added service, Tranquility Chiropractic Studio will now be billing most patients’ health insurance!

What has been interesting about this change, is how little people including myself know about their health insurance benefits.  It is interesting how many of us go to our health care provider and know little to nothing about what will and will not be covered.

Does my plan cover chiropractic?  Do I have a copay or coinsurance?  What is my deductible?  What is a deductible?  If I have a copay, is a chiropractic visit considered an “office visit” or a “specialist visit”?  Do I need my PCP’s referral?  What will I get stuck with after my insurance company pays the doctor?  Am I responsible for the amount insurance company doesn’t pay to my doctor?  Augh!!!!!!!!!!! Health insurance can be very confusing!

I had waited months to become credentialed, and here I was too…confused! In order to better understand how to help my patients get the care they deserve, I met with a billing specialist (as well as called every chiropractor I knew).  I talked for hours and asked a million questions.  Here are a few tips that I think can benefit every person who has or ever will have health insurance.

Common Insurance Questions and Answers

  1. What is a deductible? I like to think of the deductible as your upfront out-of-pocket cost.  Your deductible is the predetermined amount you are responsible for paying before your insurance company will start covering your health care expenses.
  2. How often do I have to meet my deductible? Your deductible starts over again annually, but don’t be shocked if your health coverage isn’t from Jan 1-Dec 31.  I’ve seen other dates (IE Sept 1- Aug 31).
  3. How is my deductible determined? The lower your deductible is, the higher the price of your plan (usually paid monthly).  If you have a lower deductible then your insurance company will pick up a larger portion of the bill.
  4. Who is responsible for billing the insurance company…me or my doctor? Many health care providers bill the insurance company as a service to you, but it is ultimately the patient’s responsibility to ensure that provider is paid for his or her services.  Whoever bills the insurance company has the most risk of revamping the cost of service!  Please remember, if your insurance company doesn’t pay, you may have to! So if your provider bills for you, make sure you understand what amount you are responsible for if the insurance company decides not to pay for part or all of your care.
  5. My insurance company didn’t pay for my treatment and my doctor wants me to pay.  Who’s fault is it…my doctor’s or my insurance company? So you’re in a situation where your insurance company did not pay for part of your services, and your doctor is asking you to pay the amount not covered.  Frustration can arise when you get an unexpected bill, but stay calm.  Either party could have made an error- your doctor’s office may have billed the claim incorrectly or the insurance company could have paid or not pay the correct amount.  If you get a bill from your provider’s office, call and ask why the services were not covered.  But remember, if your insurance provider doesn’t pay, ultimately you are responsible.  Luckily, most doctors are doctors because they love to help people.  So always assume your doctor will work with you to make sure you can afford your care!

For more information, check out these links!

Taking a little stress out of your day!  -Dr. Funk


One Response to “Health Insurance Confusion”

  1. Mia Says:

    Health Insurance is confusing. I liked this post! Thanks, Dr. Funk

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