At Davam, we want to make sure that patients have a full understanding of the costs associated with their urgent care visits. With the new year, most insurance plans start over which could mean changes associated with your health benefits. Our in-house billing team had some great tips to offer regarding new changes.
- Have a current insurance card with you. In order to correctly verify your benefits, we will need a correct insurance card. A temporary, paper card will work until the actual card comes in. If we are unable to verify your benefits at the time of service, you will need to prompt-pay.
- Familiarize yourself with your new benefits. The more you know about your benefits, the easier the check in process will be at the beginning of the year.
- What you pay at one office, might be different than what you pay at another. Each office, depending on the level of care and type of service offered, could have different up-front costs.
Helpful Terms When Looking Over Your Plan Details:
Health Insurance Deductible- This is the amount that the patient typically must pay out-of-pocket before the insurance company will start to pay
Out-Of-Pocket- The maximum amount an individual/family will have to pay for the calendar year for services covered under their health insurance plan ( includes deductibles, copays, and coinsurance)
Copay- A copay is an amount you will pay for a covered health service. Typically urgent care copays are much less than what you would pay at an emergency room. Insurance requires that these are paid at every visit.
Coinsurance- The percentage of costs you pay, following your deductible amount. Coinsurance amounts will vary based on each insurance plan.
HMO Plan- Health Maintenance Organization. With an HMO plan, you are assigned a specific pcp. Referrals are required for certain providers. . Please check with your insurance carrier to see if a referral is required for our facility. Being seen without a referral could result in denied claims and higher out of pocket expenses.
PPO Plan- Preferred Provider Organization. With a PPO plan, you do not have to select a primary care doctor and referrals are not required.