Tips to Simplify Medical Reimbursement

Medical reimbursement is generally one of the last things you think about when you are sick and in need of care. However, if you take a few minutes to think about how the bill will be paid and the speed to which your medical claim will be processed correctly it can save you on future headaches about unpaid bills and paying more of the costs for a simple visit to the doctor. There are some key areas you need to be aware of when it comes to utilizing your insurance benefits and the amount of medical reimbursement you pay.

General Tips

• Whenever you call for visit to the doctor, hospital, etc., make sure you have a copy of your card in front of you to provide the membership information to the caller. Make sure you are aware of which providers of care are participating (accept) in your insurance plan and go to them rather than a provider who does not participate or is out of network (does not accept). A non-participating provider fees are more than a participating fees.

Doctor Visit

• Most health insurance carriers want you to have a primary doctor that you seek out when you need routine services, check-ups or are sick. So, when you schedule your appointment with a doctor for these services, be aware of your required co-pay for regular visits and for physicals. Some insurance carriers have a reduced co-pay for your physical visit versus a visit when you are sick.

Specialty Doctor Visit

• A specialty doctor is a doctor that provides care to you outside of what a primary doctor provides. For example, a dermatologist, a cardiologist, a gynecologist, an obstetrician, or a gastroenterologist are some type of specialty doctors. When you seek care for these services you need to be aware of your co-pay as well. These co-pays are generally higher than the co-pays for a regular doctor.

  Another area that can cause reimbursement problems for you when you seek care from a specialist, is not knowing when a paper referral or authorization is needed prior to seeing the specialist. Your insurance carrier may require you to obtain permission from your primary doctor that you need a specialist at this time. The primary doctor must provide a written request to the specific specialist for your specific problem before you can schedule a visit with the specialist doctor. If you do not get a referral, then you could be responsible for the bill.

Hospital Visit

• You cannot be admitted to the hospital without your insurance company knowing about it either ahead of time or within 24 to 48 hours of an emergency. If you know you will be admitted on a non-emergency basis, you need to call the insurance carrier yourself and verify that authorization was received for you to be admitted by the admitting doctor or through your inquiry.

  An emergency room visit costs more at the hospital than it does at an urgent care center. If there is an emergency ankle injury, illness, fever, etc., before midnight and the urgent care center is open, go there. Even with insurance, the emergency room visit is going to cost you anywhere between $50 and $100 for the visit. The urgent care center could simply be your primary co-pay amount or a much lower urgent care co-pay of about $15 to $50.