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Understanding Your Health Insurance and Medical Bills

By MARY ELLEN KALUZA Understanding your health insurance policy can be an exercise in crazy-making. Very few of us have insurance policies that cover everything. What isn’t covered shows up in medical bills. A little knowledge can help make sense of it all. INSURANCE PLAN TERMS Premium: This is what you pay to have insurance. Insurance through your employer is deducted from your paycheck. Otherwise, it's a regular bill like auto insurance. Copay: A fixed amount you pay for a medical procedure or an office visit. The copay amount may be different for different services. Not all insurance plans have a copay. Deductible: This is the amount of medical bills you must pay 100% before your insurance kicks in to pay expenses. This amount can range from a few hundred dollars to several thousand. Knowing how much your deductible is will help you plan for medical expenses. Coinsurance: After you have satisfied your deductible, your coinsurance kicks in. Typically, plans will cover 80% and you are responsible for 20% of the bill - your coinsurance. These percentages can differ depending on the medical procedure or provider. In-network or out-of-network: In-network providers have an agreement with your insurance company to provide services at a certain cost to their policyholders. You usually pay more to see an out-of-network provider. Out-of-pocket limit: This is the amount you must pay each year before your insurance will cover you 100%. The amount is often in the thousands of dollars. The out-of-pocket limit does not include your premium payments. MEDICAL BILLS Medical billing isn’t uniform, so if you go to different clinics or practitioners, your bills may look totally different. And you may receive extra bill-like notices to help increase your blood pressure. Statement: You could get multiple statements for the same service. Your provider sends a bill (aka claim) to your insurance company and may send you a statement, too, with a [...]

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