My friend Sally is super friendly, smart and has a great job.  Sally recently explained to me that she is very annoyed with her doctor’s office.  Why?

She was at her doctor’s office last week and she was trying to figure out whether one of the healthcare services she wanted was going to be “paid for” entirely by insurance.  

She kept asking the doctor’s billing people, “Is that covered?”  Although the billing people said “yes,” she later got a big bill from her doctor.  How could this be?

Healthcare has a lot of specific language that you need to understand.  If you ask the wrong question, you might not get the answer you were looking for.

“Covered” services: are healthcare services that your health insurance “covers” under your health plan.  So you might think, “If it’s covered, I won’t have any out-of-pocket costs.”  Think again!

Most insurance plans have co-pays and deductibles.  If you haven’t met your deductible for the year, you will likely have to pay for the whole service even though it’s a “covered” service.  Until you meet your deductible, you will have to pay for the services yourself.

Likewise, most insurance plans have co-pays for certain services.  For example, the cost of your doctor’s visit may “covered” but you may have to pay between $5-20/visit because that is your co-pay for the service.

Again, if you only ask, “Is this service covered?”  You are not likely to get the answer you are looking for.

Asking the right question can help you get the answer you are looking for.

Let us know what you are annoyed with your doctor about.  Leave us a comment below and let us know what is on your mind.

For more information about your health insurance, see HealthSpin’s Easy Healthcare: Choosing Your Health Insurance.

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