Maximize Your 2016 Benefits

Maximize Your Health Benefits

 

Get the most of your health benefits
before the end of 2016

Here at Excel Chiropractic, we want to help you get the most out of your health insurance benefits, possibly saving you money in the future, before we wrap up on 2016. The holiday season has arrived and your calendar is filling up with obligations. But, even though your time is already limited, it might be worthwhile to add a few chiropractic appointments to your schedule.

Here are four common scenarios that can help you make the most out your time, money, and benefits:

1. You've Met Your Deductible
This is the amount you must pay of your health care before your insurance starts covering a portion of the cost. This amount usually resets at the beginning of the year, so if you have met your deductible, or are close to the cut-off, your medical care will rendered at a lower cost to you until the end of the year.

2. You Have Money Left in Your Flex Spending Account
If you set up a flex spending account, you were able to contribute pre-tax money to it each year and use that money for qualifying health expenses. If you have funds left in your FSA, or you are over your rollover limit, it’s time to spend the money.

3. Take Advantage of Benefits that may be Changing in 2017
Carefully review the information about your insurance benefits, and see if any benefits are being cut or reduced in 2017. This may include: rising co-pays, switching to a deductible only plan, fewer chiropractic visits that are allowed per year, etc. If you will be affected by any changes, get the most out of your coverage now before the cost of your treatment goes up.
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There are many ways of addressing chiropractic needs now, instead of waiting until next year that can save you money. As always, if you have any questions or concerns regarding your health insurance benefits, just give our office a call. We are all well versed in the ins-and-outs of insurance and would be more than happy to help.

Understanding Insurance: Basic Terms

Understanding Insurance
Basic Terms

      Hey everyone, Kelcey here! After working for Excel Chiropractic for over three years and being responsible for all things insurance related, you can probably guess that I get a lot of people asking me for help in explaining their insurance benefits. I regularly get calls from family and friends, asking for one thing or another to be explained. I know insurance can be confusing, so I thought I would create a series of blogs that would allow me to share what I know and hopefully answer some common insurance questions.

** Please Note: I am not an insurance expert. All terms and actions are explained to the best of my abilities and in accordance to Excel Chiropractic’s policies and procedures (aka: very by the book, we love to follow the rules here!)

***Also Note: These are basic terms and explanations. I will explain what occurs with the MOST COMMON insurance plans. There are outliers that exist to throw everyone for a loop. Ultimately, there is no guarantee of benefits and they will be fully determined when the claim is processed (aka: we will abide to the benefits presented to us when we receive the claim back from the insurance company. This means your benefits may be different from what we were originally told.)

Basic Terms:

·         In-Network: Refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.

o   Sometimes referred to as a preferred provider by insurance companies

·         Out-of-Network: Refers to a patient seeking care outside the network of doctors, hospitals or other health care providers that the insurance company has contracted with to provide care.

o   Often, insurance companies do not hold benefits for out-of-network providers, leaving the patient responsible for the bill in full.

·         Co-payment or co-pay: A set amount that the insured (patient) is required to pay at the time of services. This payment may or may not cover all services you receive in the office

o   Some services, for example: x-rays, may be subject to your deductible. While we are able to tell you what will and won’t be covered in our office, if you visit a larger organization (such as Avera or Sanford), you may want to review your insurance coverage before being seen.

·         Deductible: A certain amount of money the insured is required to pay out of their pocket before the insurance company will begin to pay claims.

o   Most family health insurance policies have both individual deductibles and family deductibles.

§  Individual Deductible: A certain amount of money each individual insured on the insurance policy must pay. Once met, the insurance company will begin to pay on services for that individual only, but not for other family members.

§  Family Deductible: Each time an individual within the family pays toward his or her individual deductible, that amount is also credited toward the family deductible. If the family deductible is met, health plan benefits kick-in for every member of the family whether or not they’ve met their own individual deductibles.

o   Most deductibles are annual, meaning they last for the contracted plan year. They will reset at the beginning of the next contracted year, requiring the insured to pay out of pocket once again.

o   There are typically separate deductibles for in-network and out-of-network services.

·         Co-Insurance: Defined as the insured’s share of the cost for health care services. If is usually figured as a percentage (like 20%) of the insurance company’s allowed amount of charged services. A co-insurance comes into effect once the individual or family deductible has been met.

o   Example: If the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount (80%).

·         Out-of-Pocket Max: The most an insured will pay during a policy period before their health insurance or plan starts to pay 100% for covered health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the health benefits.

o   Like with the deductibles, there is usually an individual and a family out-of-pocket max.

o   Commonly, there are separate out-of-pocket maximums for in-network and out-of-network services.

These are the most basic terms that a provider’s office will deal with on a daily basis. If you have any questions or concerns regarding your insurance policy and how it works, please do not hesitate to give me a call at the office. I highly suggest having a basic idea/understanding of your insurance coverage before receiving care at any provider’s office. 

If you would like to see a post about a certain insurance term/question, please do not hesitate to let me know. I will do my best to answer any questions or explain any issues!