A couple of months ago I received a bill from my doctor's office with an amount higher than I had expected. When I contacted the insurance company, they initially stated that the amount was correct, yet I continued to press them and requested that they break down the charges in detail. As they went over the details with me, I realized there were discrepancies between what I knew my plan stated and what they were telling me my coverage was. As a professional in Human Resources, my job requires me to have a good grasp of benefits. Yet, it’s still difficult to navigate the healthcare world—especially with all the changes being implemented. While I can’t go into detail regarding every plan, there are some general terms and tips that every person who has health coverage should know:

1. Co-pay

This is the amount that you pay each time you go to the doctor and receive medical care. It may differ for each type of doctor you see, i.e. primary care physician, specialist or an ER professional. This amount may be found on your insurance card, but if not, make sure to know what it is prior to your appointment as a lot of doctors now require payment at the time of service, and you do not want to be surprised when you get to the doctor's office.

2. Out-of-pocket maximum

Many plans have a set dollar amount which is the out-of-pocket maximum that you have to pay within a given plan year. Generally co-pays do not count towards the out-of-pocket maximum, but double check with your plan. In my case, the bill exceeded my out-of-pocket maximum, which was a red flag that my bill was not processed correctly.

3. Wellness visits

There have been some changes with the Affordable Care Act regarding coverage of wellness visits and preventative care. Many plans cover 100% of these visits and there is no co-pay. Definitely take advantage of these benefits as they may save you both in terms of money and your health. One of the charges on my bill was a wellness visit, which I questioned since I knew it should have been 100% covered.

4. Never assume the bill is correct

There’s room for error when it comes to billing—from the wrong billing code being entered at the doctor's office to the insurance company looking at an incorrect plan. When I got married and switched to my husband’s insurance policy, I found that I was still being billed under my old insurance. The mistake was made because my new plan was with the same insurance company as my previous policy. It was a simple mistake, but it caused unnecessary expenses.

5. Ask questions

It can be intimidating to look at a bill with technical medical descriptions, credits, fees and pending insurance payments. Be sure to ask questions if you are unclear on what is being charged. The billing office, insurance company and your company's HR department are all resources for you. While it may seem easier to just pay your bill rather than truly understand it, putting forth the effort may just save you some money in the end.

After all was said and done I ended up getting my bill reduced and saved $162. While there are many different insurance plans out there and at times it may be difficult to decipher all the jargon, remember it’s worth the time to make sure you understand your plan. In the end, it’s your hard-earned money, and you shouldn't be paying more than you have to!


This is a guest post by Laura from Chicago.


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How to Navigate the Maze of Medical Costs