The world of healthcare and health insurance can be tricky to navigate, especially when you don’t fully know what each form is for or how to read them. For a better understanding of your health insurance policy, read on:

Knowing the Vocabulary

Before knowing how to read your documents, it is crucial to know the lingo:

 

  • Network: A network is your insurance company and a list of healthcare providers that are affiliated with that insurance company. Healthcare providers that are in-network offer discounts and benefits to insured patients.
  • Policyholder: The person who has applied for insurance and is covered by an insurance policy. These people are sometimes called “the insured” as well.
  • Premium: A monthly fee someone pays for their insurance. Government-based health insurance does not have premiums.
  • Deductible: The amount owed for healthcare coverage before an insurance policy takes effect.
  • Copay: The amount policyholders may have to pay for specific in-network medical services. This includes medications and treatments. Copays are often less than the amount an uninsured customer would have to pay.
  • Coinsurance: Your share of the cost for a covered health care service. Coinsurance is usually calculated as a percentage of the allowed amount for the service.

Reading Your Insurance Card

Everyone has a health insurance card and knowing the information on it is necessary when visiting new doctors, pharmacies, and the like. All health insurance cards have the same general information listed on them:

  • The insured’s name (you).
  • Your policy number, which is used to identify your specific insurance plan and profile. This number is also called your policy ID.
  • Your group plan number, if you are enrolled in a group health insurance plan.
  • Your insurance company’s contact information, including phone number, fax number, and emails when applicable.
  • Your primary care physician.

Explanation of Benefits

An explanation of benefits is a document policyholders receive regularly from their insurance company, sometimes once a month, or on an as-needed basis. These documents contain a summary of all healthcare services provided to a policyholder for an incident or the month in summary. These documents will feature tables showing what provider was billed, how much the insurance company paid, any in-network discounts, and the total amount covered by the insurance company. The remainder of any bills will be included in this summary as well, along with a monthly total if necessary.

 

What if Something Doesn’t Match Up?

If you receive a bill, explanation of benefits, or a new insurance card with information that doesn’t match up with what you have, call your insurance provider immediately. Most discrepancies happen between medical bills and the explanation of benefits, often as a result of a missed discount or human error. It is your right to have affordable healthcare, and your insurance company will fight for you if you need assistance.

Types of Primary Headaches and What they Mean
Upgrading to an Electric Wheelchair

Related Products