It is important to know which doctors fall under the network providers listed in your insurance plan. This will help you avoid having to dip into your pocket for extra hospitals costs that aren’t covered under your health insurance plan.
Consider this scenario: You visit the hospital without knowing whether it falls under your plan’s providers’ network. You have been in an accident and broken your leg so you undergo surgery. You have already paid the deposit from your pocket, expecting to claim the same amount from your health insurer. After the surgery, you find out that all your medical costs from that day are not covered because the hospital does not fall under the providers’ network in your health insurance plan. This means that you will have to pay all costs from your pocket: anesthesia, surgery, medicine, admission, etc.
In some cases, your insurer might reimburse your out-of-network treatment/ procedure. However, the chances are high that an out-of-network hospital is more expensive than the ones in the network. This means that your medical bill might exceed your insurance limit. Therefore, you’d have to pay for the balance from your pocket. This scenario is an example of what we are referring to as ‘surprise bills’ in this blog article.
In summary, consider these tips before visiting a doctor/ hospital thinking that your treatment/ medical procedure will be covered by your health plan:
- Ensure that you know what your health plan covers. Carefully take time to learn about your health plan’s benefits so as to avoid surprise bills. Call or check your insurer’s website.
- Ensure that you know which doctors/ hospitals are under your health plan’s network of providers. This will help you avoid surprise bills by;
- Not visiting a doctor/ hospital that doesn’t fall under your health plan’s network of providers.
- Comparing different rates from different providers.
- Ask about costs of treatments & procedure so you don’t exceed your insurance limit. This will help you avoid paying any extra amount from your pocket.
Are you covered with Madison Insurance? Find out more about the benefits of Madison Alpha Health insurance at http://www.madison.co.ke/alpha-health.html.