How the HECK Does My Health Insurance Work?!
By: Hazel Rex
This is a brief introduction to Health Insurance, the basic terms, and what that means for YOU! This is not an exhaustive list, and if you have questions about your insurance coverage, we recommend reaching out to your insurance provider for clarification! Bridgercare cannot answer questions about your insurance plan as a whole, only your insurance plan as it relates to the services we provide!
What is Health Insurance?
Health Insurance is a type of contract between you and your health insurance agency that helps pay for your doctor’s visits and medical bills. In exchange, you pay the company a “premium” or a little bit of money every month.
Basic Terms
Allowed Amount: The most your insurance provider will pay for a service. If your healthcare provider charges more, you might have to pay the difference. These amounts will depend on the insurance company you choose and your medical provider.
Covered Service or Covered Health Service: This is an umbrella term that describes any healthcare service that your insurance plan helps pay for. This does not mean that the service is paid for entirely, just that the service is within the terms of your contract.
Deductible: This is what a patient will pay for covered healthcare services, before the health insurance plan pays for covered services. This may not apply to all health services and does not include anything you’ve paid through your premium. Deductible amounts vary based on the patient’s health insurance plan.
Out-Of-Pocket Maximum/Limit: This is a set amount of money. OOPM is how much a patient pays during a policy period (or the length you set your health insurance contract for) before the insurance company starts paying 100% for covered services. This limit never includes the premiums already paid, or services that aren’t covered by a patient’s policy.
Co-Payment or Copay: This is a pre-determined, fixed fee (for example, $25) that a patient will pay for a covered healthcare service. This amount can vary between visits, depending on the type of service, and type/specialty of the provider.
Co-Insurance: The amount that a patient must pay for a covered service. Usually, this will appear as a percentage (i.e., 30%) of the amount allowed for the service. Most of the time, a patient will pay 100% coinsurance until they meet their deductible.
Insurance Network: This is another contract, but it’s between your healthcare provider and health insurance company. This contract determines how discounted a healthcare provider will be, and in exchange, a health insurance company will allow that provider access to the patients that they have contracts with.
Balance Billing: When your provider bills you because the cost of the covered service you received is greater than the allowed amount for that service. For example: your insurance might pay $100 of a service, but your doctor charges $150. You would be billed the remaining $50. Balance billing ONLY happens when you see an Out-Of-Network provider. In-Network providers cannot balance bills!
How does this all fit?
While you sign a contract with the insurance provider, they also have contracts with healthcare providers! All of this comes together to lay out who is responsible for paying certain amounts of money. Choosing which insurance plan is right for you can be complicated. Consider your current needs, things that may occur in the future, and how high of a premium you are able to pay.
Bridgercare services are often supplemented through the federal funding we receive! If you do have insurance, we check if we’re in network like any other healthcare provider. If your insurance doesn’t cover the cost of care or if you’re responsible for copays, the sliding fee scale might reduce your out-of-pocket costs based on your income. This applies to all insurance.
If you are uninsured or certain services aren’t covered, our sliding fee scale can be used to determine a reduced cost! Bridgercare will assess your self-reported income, determine if you qualify, and adjust your service fees accordingly. No matter what, everyone is able to get services at Bridgercare. For more information on Bridgercare’s insurance and billing, click here!