It’s critical to understand what services your insurance coverage offers as well as your expected expenses before your physician’s appointment. Here are a few questions to consider:

Is My Insurance Plan Included In My Current Physician’s Services?

  • Call your physician’s office directly and make sure they accept your health coverage. You can also find out from your State company website and supplier directory.
  • Additionally, you should check with your health insurance company if you need pre-authorization before your visit. Without it, you might be charged for services that your health insurance would have covered.

Does My Health Insurance Cover The Facilities I Need?

  • All the private health insurance coverages available in the Marketplace provide the same “essential health benefits,” such as emergency services, prescription drugs, maternity, pregnancy, and newborn care.
  • Some policies may also include additional services. If you have any concerns about whether a service is covered, call your insurance agent.

What Will My Expenses Be?

  • Most health insurance plans provide you the best terms of service when you visit a doctor who has a contract with your plan (also known as an “in-network” supplier). You might be able to consult doctors who do not have contracts with your program (called “out-of-network” suppliers), but you may have to pay more out-of-pocket costs.
  • Before your appointment, you can avoid unpleasant surprises by learning which services in your plan are not subject to your insurance coverage deductible. Some programs only charge a copayment for primary doctor visits before you meet your insurance deductible; others provide drug discounts, like generic drugs.