Content Overview
- Summary
- Keep Track Of Out-Of-Pocket Medical Expenses
- Keep Your I.D. Card With You In Your Wallet Or Purse
- Use In-Network Doctors And Other Health Care Providers As Much As Possible
- If You Have A Choice, Choose More Protection Instead Of Lower Premiums
- If You Agree To Surgery, Make Sure All Members Of The Team Are In-Network
- Negotiate Fees With Out-Of-Network Health Care Providers
- Think Of Case Managers As A Resource
- Stay On Top Of Insurance Company Reimbursements
- Avoid Paying Money In Excess Of Usual, Customary And Reasonable
- Be An Informed Consumer When Purchasing Drugs, Tests Or Treatments
- Take Advantage Of Discounts And Wellness Features
- If You Smoke, Quit
- If You Need An Off Label Or Experimental Treatment, Work With Your Doctor To Get Coverage
- Don't Accept A "No" From The Insurance Company
- How To Choose And Maximize Use Of Doctors And Specialists
- Take Advantage Of Your Plan's Mental Health Benefits
- How To Keep Your Doctor When You Change Health Plans
- Insurance Policies Are Not Set In Stone
How To Maximize Use Of A POS Health Insurance Policy
Avoid Paying Money In Excess Of Usual, Customary And Reasonable
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An insurer will not pay medical expense above Usual, Customary and Reasonable (UCR) for your geographic area. To get an idea of how this could affect you: If a bill is $1,000, the UCR for that procedure is $800, and your co-insurance is 80%: you will have to pay $160 for the co-insurance feature (20% of $800) plus $200 (the difference between the amount of the bill and UCR.)
An insurer will not pay medical expense above Usual, Customary and Reasonable (UCR) for your geographic area. To get an idea of how this could affect you: If a bill is $1,000, the UCR for that procedure is $800, and your co-insurance is 80%: you will have to pay $160 for the co-insurance feature (20% of $800) plus $200 (the difference between the amount of the bill and UCR.)
The company that gathers data that is used in UCR does not make the numbers available to the general public. Even if it did, each company then applies its own formula to the base data.
If you are concerned that your out-of-network doctor or other health care provider may charge more than UCR, contact your insurance company prior to incurring the expense. Ask how much UCR is for the appointment, test or treatment.
If you and the insurance company disagree, see Arguments To Use Against An Insurer's Denial Of A Health Claim (tthe section titled: A Claim Denied On The Basis That The Charges Are Not Usual, Customary and Reasonable).
Also consider speaking with your doctor about lowering his or her fee. Studies show that people who negotiate fees with doctors are successful at least 50% of the time. To find out what Medicare pays for the procedure, see www.cms.hhs.gov , look for physician's fee schedule.
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