There are certain healthcare services and treatments that are covered by health insurance plans, and it details how much each service will cost and how much you are responsible for. You can also find out which healthcare facilities and providers are in your plan if you have a managed care plan, which most Americans do.
Find out what your insurance will and won’t cover, and how much it will cover, before visiting a healthcare provider.
Your healthcare provider will usually file your insurance claim after you visit them. Regardless of what the provider claims, the insurance company will pay out set rates for each type of service.
If your healthcare provider is in-network with your plan, the balance will simply be zeroed out. In out-of-network situations, you are still responsible for what the insurance company does not cover. In the event that your insurance doesn’t cover all of your costs, you may still receive medical bills.
In addition, your claim could be denied altogether, and you would have to pay the entire amount yourself. According to your insurance policy, your insurer must inform you in writing if your claim is denied. You must also be provided with contact information as well as information about the appeals process.