Health insurance benefits can be confusing, but a better understanding of your benefits can ultimately help you save time and money. Prior to setting up an appointment, here are four things you need to know to make the most of your insurance benefits.
1. Confirm that the provider is in your network
Most insurance companies use a specific group of doctors, hospitals and other health care professionals who make up their provider network. When searching for primary care physicians or specialists, confirm that they are in your insurance provider’s network. You can do this by calling the insurance company or visiting its website to search its provider directory. If you choose to see a doctor outside of your network, there may be additional costs for your visit.
2. Know if you have an HMO or a PPO
HMOs (health maintenance organizations) and PPOs (preferred provider organizations) are two of the most common types of health insurance providers. A quick glance at your insurance card may help you determine if you have an HMO or a PPO. The bigger question is, what does this really mean? HMO insurance usually requires patients to see providers within their network and usually requires that you receive a referral from your primary care doctor before you see a specialist, such as a cardiologist or a dermatologist.
By comparison, PPO insurance allows patients to see any provider of their choice, regardless of whether they are in network, although there may be additional costs to see “out of network” providers. Patients with PPOs are also able to schedule appointments with specialists without a referral from a primary care doctor.
If you have a health insurance plan other than an HMO or PPO, it is best to contact your health insurance provider to determine the benefits available to you.
3. Identify your co-pay and deductible costs
Co-pays and deductibles vary based on your health insurance benefits package. A co-pay is the fee that you are responsible for paying at the time of your appointment. This cost will contribute to your out-of-pocket deductible. A deductible is the total amount you must pay each year before your health insurance will begin to cover medical expenses.
Typically, your co-pay and deductible information will be listed on the front or back of your insurance card. You can also contact your insurance provider to learn more about your plan’s co-pay and deductible amounts and requirements. Based on that information you will be able to anticipate what costs you are responsible for at the time of your appointment and the total amount you will have to spend before your insurance starts covering some or all medical costs. This will also help you prepare to pay your patient responsibility at the time of service.
4. Determine what services and treatments are covered
Prior to scheduling any surgery, tests or treatments, check with your health insurance provider to determine which costs it will cover and the costs for which you are responsible. Your insurance company can provide you with a detailed summary of your benefits and coverage so you can see what services and procedures are included in your plan. In some cases, your insurance company may request that you provide procedure codes to determine your coverage. If needed, your health care provider can give you those codes and any other information your insurance requests.
Appointments with UT Health San Antonio
UT Health San Antonio is here to help our patients plan their costs and understand their billing information. Contact our patient financial services department Monday through Friday, 8 a.m.–5 p.m., at 1-800-410-2777. If you have a MyChart account, you may log into your account to send a message directly to our patient financial services team.
We accept most major insurance plans, including Medicare. Review our list of accepted insurance.
When you’re ready to schedule your next appointment, call us at 210-450-9000.
For more information about UT Health Physicians, visit www.uthealthcare.org.