Getting to know insurance

It’s that time of year again.  The time of year where we all think about our family.  No, I’m not talking about the holiday season; I’m talking about insurance!  It is the time of year where you have to decide on the plan that is right for you and your family.  So…what is the right plan for you and your family?  While I can’t help you with that decision, I can help clear some things up which might help make your decision a little easier.

First, whatever insurance you choose, that is a contract between YOU and YOUR insurance company.  Any doctor that you may go to that is in network with your insurance company has a contract between the doctor and the insurance company.  The doctor’s office can only see small amounts of information about your plan.  They can’t call the company on your behalf and find out any information because that would be a breech of the contract YOU have with the insurance company.  In our office, we do our best to help you navigate this process.  We are more than willing to tell you what to ask or say in a certain situation.  I think anyone working in a doctor’s office should do this, but it isn’t always the case.

Deciding on a deductible amount can also be an issue.  The deductible is the amount of money you have to pay before your insurance company will start paying for anything.  Usually, the lower the deductible, the higher the cost each month.  If you don’t go to the doctor very often, a high deductible might be a good idea.  I would suggest that if you do pick a plan with a high deductible that you also plan on saving some money each month that might help contribute to the deductible should you ever need it.  Another issue is a family deductible.  Usually a family deductible is spread out through anyone who is on the plan.  Each individual member must meet their own personal deductible before the benefits will be paid out for that family member.

Now we move to copay or co-insurance.  A copay is an amount of money you will pay the doctor at your visit.  These vary greatly.  Usually, they are dependent on the plan you choose, and the type of doctor you go to.  A general practitioner will usually have a lower copay than a specialist like a cardiologist.  Chiropractors fall into a weird category.  On some insurance plans, we are considered specialists, on others we are not.  Every insurance company is different, so you won’t know until you ask either the doctor or the insurance company.  A co-insurance is usually a percentage you pay after the insurance has paid their portion of the bill.  You won’t have to pay anything when you go to the doctor.  The doctor will bill your insurance, and once they find out how much your insurance paid, you will get billed a percentage.  Pay attention to the percentage of a co-insurance when you are deciding on a plan.  I have seen them as high as 50% being the patient’s responsibility.  Also remember, if you haven’t met your deductible for the year, none of this applies.

If you are getting insurance through your employer, there are ways that they can make it more cost effective for everyone.  These are called Health Reimbursement Accounts, Health Savings Account, and Flexible spending accounts.  A health reimbursement account (HRA) is an account employers use to reimburse employees for health care expenses.  These are only paid after you incur expenses.  If you have one of these, you’ll need to get some sort of a receipt from your doctor.  Depending on the employer or the insurance company, you’ll need a receipt of payment and what is called a super bill.  Your doctor’s office should be able to give you either of these easily.  This type of plan is usually more beneficial for the employee.  Some employers allow their employees to roll this over into the next year. The Health Savings Account (HSA) is an account established by the individual to pay for qualified medical expenses.  You are allowed to take out a certain amount of money tax free to put in this account.  You can then use this to pay for medical expenses.  This type of account usually goes well with a plan that has a high deductible.  If you don’t go to the doctor a lot, you’ll never meet your deductible, and this plan will allow you to go a couple of times and have some saved money to pay for the visit.  Usually these will roll over since it is something you set up.  Some employers will match your contributions, also with a tax break.  Finally, there is a flexible spending account.  This is set up by your employer.  They own this account, but you get to decide what medical expenses you will pay with this account.  Until recently, this account was a “use it or lose it” deal.  Now, they allow up to $500 to be rolled over to the next year.

I know this is a lot to take in.  Hopefully I cleared some things up for you!  If you have any questions, don’t hesitate to ask.  Annie and I are always more than happy to help in any way we can!

~Dr. Stacy



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