In Illinois (and the entire US, possibly), who is responsible for verifying health insurance coverage (if doctor is in-network) and if any procedures done (echo, stress test, blood draws, etc) are covered? Should it be the patient or the doctor's office? Shouldn't dealing with the professionals in the insurance company be done by professionals in the doctor's office, instead of the patient who sometimes does not understand half of how the health system works?
Insurance - 5 Answers
Random Answers, Critics, Comments, Opinions :
1 :
It's your health, and your bank account that will be affected, so you should be the one checking the coverage and procedure approvals. You don't have to understand how the entire health system works, you just should be capable of asking an insurance care representative, or your HR representative, whether procedures are covered, and how much.
2 :
it is your responsibility to verify if a provider or service is covered. this is why you are given a plan benefit book that shows your benefits and coverage limits. 95% of people do not read it.
3 :
Ultimately, it's up to the insured person ( or their parent, if they are a minor) to verify health insurance coverage and in network status. Most doctors' offices do it as a courtesy, but what they find out is NOT BINDING. As with all other financial dealings, the patient really really needs to educate himself about how the health system works, instead of relying on someone else to take care of you. People here in the USA have to grow up, and start taking some responsibility for themselves, their health care, and their finances.
4 :
I have seen so many times on Y/A that a person goes to the doctor and they confirm that something is covered, then later get this huge bill they end up paying and get upset since the doctors office called and they relied on that info. To learn how this health system works, you need to get on the phone YOURSELF and ask questions before you treat if possible. The doctor maybe in-network, but the tests they do may not or sent to labs that are out of network, thus you pay a lot more. When YOU talk to YOUR insurance company, they will explain if you will be out of pocket a deductible, co-pays or co-insurance which can add up. Unfortunately in today's world, we think we can get treated and the insurance will pay, but many times even if something is covered, it could be less than your deductible, thus you pay the full amount. Only in the US, no one really knows what any procedure, test costs until you get a bill and find out, since they don't post them at the doctors office so you know ahead of time. Most doctors get paid per procedure/tests that are done, whereas each procedure/test could be on your dime, so sometimes you have to ask? Do I really need this test/procedure? good luck
5 :
try this: http://www.insurance.2arz.com
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