understanding your health insurance benefits
Is Intouch in-netowrk with your Health insurance carrier?
All Clinicians are In-Network with Aetna, BlueCross BlueShield of Illinois, Blue Cross Community, United Health Care PPO plans. Some Clinicians are In-Network with Medicare and Medicare Advantage Plans. All other health insurance carriers are billed out-of-network. Clients are responsible for all deductibles and out-of-pocket costs.
how much can you expect to pay for services you receive from an in-network provider
The amount you will have to pay for services you receive from an in-network provider will vary depending on your plan. Some plans require you to pay a deductible before your insurance carrier will begin to contribute toward the cost of your services. Other plans are written so that you will only have to pay a co-pay or co-insurance regardless of whether or not you have met your deductible. Some will require you to pay a co-insurance until you reach the maximum out-of-pocket costs which your plan will expect you to pay.
what to do if your health insurance has not contracted with Intouch
If your health insurance carrier has not contracted with us, you should consult your plan documents or call your carrier directly to ask them if you have out-of-network benefits, if yes you should ask what your benefits are. In many cases, health insurance plans that have out-of-network benefits will often require you to pay more out-of-pocket than you would with an in-network provider. Additionally, when your insurance company has not contracted (negotiated a rate) with a healthcare provider, providers will expect you to pay their published fees for the service you receive, therefore, it is important for you to know your provider's out-of-network fees. Do not be caught by surprise, know your benefits, contract with your out-of-network provider upfront, before you receive services in order to minimize your out-of-pocket expense.
You should know that there are some insurance plans do NOT have out-of-network benefits. This means that your health insurance plan will NOT pay any portion of the services you receive from a provider who is not in your plan's network. If you choose to receive services from a provider that is not in network with your insurance, you will be responsible for the full cost of the services you receive.
What do the terms Deductible, co-pay, co-insurance, and maximum-out of pocket mean?
OUT-OF-POCKET MAXIMUM
The term out-of-pocket maximum refers to the maximum amount your insurance plan will require you to pay for your services in one year. Your out-of-pocket costs can most of the time be understood as the sum of your deductible, co-insurance, and copay.
DEDUCTIBLE
A deductible is simply an amount of money your insurance company will require you to pay for your services, before they will begin to pay for any part of them. It is important for you to know two things about your deductible: 1) If you will be using out of network benefits, it is very likely that the amount of your deductible will be substantially larger than if you use an in-net-work provider; 2) Some plans may continue to require you to pay a co-insurance or co-payment even after you have met your deductible.
CO-INSURANCE VS COPAY
A Co-Insurance is slightly different from a co-pay. If your insurance plan requires you to pay a co-insurance, that means that they will expect you to pay a percentage of your visit cost. You will have to refer to your plan documents or call your insurance carrier to obtain the exact percentage of your co-insurance.
A Co-pay is an specified amount, determined by your plan, which you will have to pay for every visit regardless of whether or not you have met your deductible or out-of-pocket maximum. What is important to know is that a co-pay can be as little as $10 but as high as $75. Some plans assign a co-pay amount to your PCP that is lower than the amount they assign to other specialty practitioners. Here again, it is best to consult your insurance documents or call you insurance carrier to obtain the exact amount you will be required to pay.
A co-Insurance amount is different from a co-payment in that you will only have to pay the co-insurance amount until you have reached your maximum-out-of-pocket. A co-payment will in most cases be required regardless of whether or not you have met your deductible or maximum-out-of-pocket.