You visit your doctor and show your insurance card—and they tell you there’s a $25 copay.
You get a prescription filled, and the pharmacist says you owe $30, even with insurance.
You have a medical procedure and receive a bill for $300 after your insurance coverage is factored in.
What’s going on here? If you have health insurance, what exactly are you paying for?
Healthcare coverage, like many other forms of insurance, doesn’t entirely eliminate your costs. It’s a shared responsibility with your insurer, and understanding how it works can be confusing sometimes.
Generally, healthcare costs, when you have insurance, can be sorted into three basic steps:
- Your costs– With the start of each new plan year, you pay for your healthcare services until you meet your deductible—a pre-determined amount that must be reached before your insurer begins sharing your healthcare costs.
- Shared costs– Once you’ve reached your deductible amount, your insurer will start to cover a certain percentage of your healthcare costs, called your coinsurance, until you reach the maximum amount that you or your family pay during a benefit period, an amount called your out-of-pocket maximum. You also continue to cover any applicable copays during this period.
- Insurer costs– Once you’ve reached your out-of-pocket maximum, your insurer pays all covered costs for the rest of the plan year. When the next plan year begins, so does this three-step cycle.
The easiest way to find out what your copay, deductible and out-of-pocket amounts are is to ask your insurer or employer for a summary of benefits and coverage, or SBC. This document shows how you and your insurance plan share costs for covered health care services, and it will list specific amounts related to your coverage.
Once you know which costs you are responsible for, you can take steps to save money by choosing the most affordable healthcare options that suit your preferences and needs.
To help you get the care you need at the most affordable price:
- Look in your provider network– Insurers typically contract with numerous doctors, hospitals and health systems for more cost-effective services and treatments. These providers are referred to as being “in-network” and typically are less expensive than other, “out-of-network” providers. Capital Blue Cross, for instance, offers an online “find a doctor” tool where members can find in-network doctors by name, location, specialty and more.
- Research potential costs– There are tools available to help you estimate costs before you seek non-emergency treatment. Again, Capital Blue Cross’ “find a doctor” tool can help. Members can use it to get cost estimates and compare prices for office visits, procedures, surgeries, tests and vaccines, and learn more about other treatment options before deciding where to go.
- Choose the right place for the care you need now– Emergencies can happen, and in some cases, your nearest emergency room is the right place to go. But using other nonemergency options in some instances can get you faster, more affordable care. Consider these options:
Telehealth – Schedule a virtual visit by smartphone, tablet or computer on your schedule from wherever you are. The Capital Blue Cross VirtualCare app offers members round-the-clock access to doctors for many common healthcare needs, including behavioral health visits with counselors, psychologists and psychiatrists. The service even includes nutrition counseling.
Office Visit – A visit with your doctor can be a good place to start if you prefer in-person care. Your doctor can keep a history of your health and refer you to a specialist or hospital if needed.
Urgent Care – Visiting an urgent care center for nonemergency situations that require in-person treatment is two-to-three times less costly than an emergency room visit.
Emergency Room – In a true emergency, go straight to the nearest hospital ER.
Knowing how to get the right care at the right time can help you save money, while also ensuring that you or your family stay healthy.
For more health and wellness news and information that can benefit you, visit thinkcapitalbluecross.com. This column is sponsored content.
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