June 2024

For many Americans, medical insurance feels needlessly complex, making finding a primary clinic and scheduling regular checkups overwhelming. However, understanding your family’s medical coverage is crucial to making informed health decisions.

Learn how to navigate the healthcare system effectively and find the right family health clinic that aligns with your policy by reviewing the tips below.

Review Your Policy Documents

Get familiar with the terms, conditions and exclusions outlined in your policy. Pay attention to details such as copayments, deductibles and out-of-pocket maximums. While the technical jargon may feel intimidating, spending a little extra time with the documents and contacting your provider for assistance can help demystify your policy.

Find Providers in Your Network

Most insurance plans have a network of healthcare providers with whom they have negotiated discounted rates. Know which hospitals, doctors and pediatric care specialists are in-network for your plan. The alternative is a costly out-of-network provider.

Know What Services Are Covered

What an insurance plan covers varies by policy. Essential services like emergency care and hospitalization are typically covered, but some mental health services and prescription drugs may not be. Review your options to save yourself money and stress later.

Understand Deductibles, Copayments, and Coinsurance

These three terms are key when deciphering medical insurance coverage. A deductible is the amount you must pay out-of-pocket before your insurance starts covering costs. A copayment is the fixed amount you pay for specific services. Coinsurance is the percentage of costs you must meet after the deductible.

Check for Preauthorization and Referrals

Some insurance plans require preauthorization for certain procedures, which involves getting approval from your insurance company before receiving care. Other plans require referrals from primary care physicians for more specialized consultations. Save yourself the surprise later and figure out what procedures require a go-ahead.

Know Your Limitations

Some insurance plans are quite comprehensive, but no plan covers everything. Understand what the limits and exclusions of your policy are. Commons exclusions include cosmetic procedures and certain elective surgeries.

Find Help

If you are struggling to understand your family’s medical insurance coverage, you’re not alone. Fortunately, there are customer service representatives at your insurance company who are happy to help. Give them a call for any clarification you need.

Richfield Medical Group’s Insurance Guidelines

For new or established patients with insurance, co-payments are required at the time of services rendered. Once your insurance company has processed your claim, a billing statement will be received. Contact your insurance company directly for questions about how your claim was processed.

For new patients with no insurance (i.e., someone who has never been seen by us or has not been seen in 3 years), you will need to make a partial payment of $150 for office visits, $200 for pre-operative visits and $250 for preventive/routine visits at the time of services rendered. Any remaining balance must be paid in full upon receipt of your first billing statement.

Family Health Clinic in Richfield

Whether you are working with pediatric care specialists or a general practitioner for adults, understanding your family’s medical insurance is vital in today’s healthcare landscape. Take time to educate yourself, leverage support and make informed decisions about your health plan. Medical insurance may be complex, but being proactive can save you time and money when visiting our family health clinic.

For more patient-centered insights, please contact us today.