A n ounce of prevention is worth a pound of cure, says the old cliché. When it comes to your health, its accuracy is spot-on. But what about your financial well-being? Few things cause as much deep-rooted stress and confusion as navigating your medical expenses.
It is Indiana Regional Medical Center’s priority to help you make the most of your insurance, understand your options and feel prepared.
How familiar are you with your health insurance plan? Are you underinsured? Deb Mumper, director POD patient access at IRMC, explains: “It’s critical to know your insurance plan and deductible, especially if it’s high. We’d all like to believe we won’t need insurance but that simply isn’t the case.”
Mumper advises developing a financial plan so you are prepared to pay your deductible and associated costs in the event of a health emergency.
Understanding your medical expenses begins with the basics of medical financial literacy. You might hear the terms copay, deductible, co-insurance and health network. What’s the difference?
Copay is a patient’s financial obligation due at the time of service as determined by the patient’s insurance carrier.
Deductible is a predetermined maximum amount that a patient must pay for services before the insurance carrier makes contributions. For example, a $5,000 deductible means a patient is responsible to pay up to that amount before the insurance carrier’s assistance begins.
Co-insurance is a percentage of an approved, covered amount that a patient must pay after claims are processed.
Health Network refers to the pool of physicians and hospitals available to members. Plans that exclude high-cost providers can provide lower premiums.
Upfront costs and advanced payment:
Patients and families appreciate knowing what to anticipate for their out-of-pocket costs. This way they can make informed decisions about when or whether to have elective services and discuss alternatives with their health care providers.
IRMC’s technical tools enable staff to determine approximate cost of services. In conjunction with the details of a patient’s insurance plan, staff can identify the portion of the patient’s liability that will be covered by the insurance carrier. Unfortunately, there are too many instances of patients who do not pay or are unable to do so. The result is increased loss for the hospital, which affects everyone.
“We tend to not think of hospitals as a business, but we have to maintain our financial sovereignty, or we will not be here for anyone,” Mumper says. “Our goal is to introduce patients, in advance of elective services, to available programs and assist them with medical or financial assistance applications.”
If you are part of a group health plan, discuss the details of your coverage with your plan administrators through your employer’s human resources department. If you have a personal plan, contact your insurance carrier’s member services. Contact information is on the back of your card. And remember, always bring your insurance card when seeking health care services. This ensures the bill goes to the insurance company, so they can track your care and liability.
For your peace-of-mind and convenience, IRMC has a spectrum of payment options and financial support based on your ability to pay. Balances are due within 90 days. However, patients can apply for an extended payment plan through the IRMC financial assistance program.
If you’re confused about understanding your medical expenses and options, IRMC offers financial counseling services for everybody. Financial counselors will assist you in understanding your insurance benefits and how your insurance company processes a claim that results in your bill. And it’s worth mentioning again, they are happy to help you apply for financial assistance.
Have you heard of an HSA? Do you have one? HSAs work like an insurance plan. They are an elective benefit offered by an employer as a way for employees to set aside funds to pay copays, deductibles and co-insurance expenses. Your HSA contributions are tax deductible.
When it comes to avoiding unnecessary costs, Mumper encourages people to use the appropriate level of care for their medical needs. Always start with your primary care physician, who will recommend whether you should come to the office or go to urgent care. The emergency room is for critical, time-sensitive, life-threatening situations.
In the case of understanding medical finances, a little awareness can go a long way to help you be prepared and feel better.
