In today’s world and the ever changing coverage and rules of health insurance it is sometimes difficult to know if you are choosing the right medical coverage for yourself. Here are the most common questions patients ask me:
How can I find out if a doctor is in network with my Insurance plan?
This information can be found online these day’s via your insurance plan website. If unsure about how to access and find this information as some sites may not seem user friendly you can also call your insurance carrier and inquire. There is a member phone number on the back of your insurance card. Once you confirm that your doctor or doctor you are being referred to is in network this means services provided to you will be processed at a contracted fee schedule. Co-pays, Co-insurance and Deductibles will still apply to the patients responsibly per the plan you have chosen.
Is my doctor’s office responsible for checking my coverage and benefits?
No. As with most insurance the patient’s benefits can be quite vast with all the different plans available to choose from. Also some insurance plans require prior authorizations for certain or all services rendered depending on your chosen plan such as HMO’s and Managed Care and Replacement plans for Medicare. However, here at Central Florida Pain Management we verify your coverage and any prior authorization as a courtesy to our patients to help ensure your services will be reimbursed by your plan and also to help eliminate any unexpected out of pocket cost to you. Remember coverage can change between the time it is verified and services are rendered. The benefits are the patient’s responsibility to know and understand.
What if my policy changes?
Your insurance carrier must notify you of any changes to your policy or coverage cancellation. However, keep in mind it is ultimately the patients responsibility to keep current on any and all changes.
How will I know if I need Prior Authorization?
Some insurance plans require prior authorization for certain or all services in order for the services to be paid. We here at Central Florida Pain Management will call to obtain authorization with the many plans we are participating with. However, it is your responsibility as the patient to know if your insurance requires prior authorizations.
Remember all insurance plans should provide you with a policy and coverage handbook. You can also contact your health plan via phone by calling the member phone number on the back of your insurance card and customer care will be able to answer any questions you have regarding your policy.
Blog by: Teresa McPherson, CEO