Oodles of gratitude for taking this virtual trip to the doctor with us! Here’s even more in the series “What’s Up, Doc?” Catch up with parts one, two, three, four, five, six, seven, eight, nine, and ten. And now, our last in the series… “All Better… But Ouch, THIS BILL!!”
- Your doctor is IN-network right? The doctor’s office MUST submit the bill (aka “the claim”) directly to your insurance company.
- The IN-network doctor CAN ask you for the office visit co-pay at the time of the visit. But, for medical services done during the visit…
- The IN-network doctor can NOT charge you until after the insurance company applies the IN-network discounts (the negotiated rate).
- When you get a bill from the doctor’s office, be sure that the IN-network discounts have been applied. How do you know?
- … because you got an Explanation of Benefits (EOB) from the insurance company! Check the EOB against the provider’s bill, and THAT’s how you know you’re getting the right discounts.
- If the doctor is OUT-of-network you’ll be submitting your own claims to your insurance company – and the doctor can charge you whatever she likes, there are no discounts.
- If you have an HMO, you must ONLY see a doc in your HMO group. There are NO benefits in an HMO if you go to an out-of-network doctor.
Talk to me! Was this helpful? What was your fave piece of info? Suggestions and thoughts are welcome. And as always, reach out to us for any of your insurance needs.
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