Sunday, November 24, 2013

Read Your Health Insurance Policy Before You Visit Your Doctor

Coins representing money saved by reading your health insurance policy
Save Money on Health Insurance -- Read Your Policy
When we talked about health insurance last month, I told you I owed $325 on lab work on a well visit to the doctor. If I had been alert and done my homework before going to the doctor, I could have saved about $260 of that amount -- but I didn't realize that until I got the bill.
You probably know that the codes on your medical records give a diagnosis of your condition as well as the purpose for any tests. The ICD is the International Classification of Diseases and the HCPCS is the Healthcare Common Procedure Coding System. You can read more about coding on the National Institutes of Health website.
My health insurance covers 80 percent of preventive care lab work without applying the deductible, but doesn't cover diagnostic lab work until the deductible is met. My doctor coded the lab work as diagnostic, and I came out with a $325 charge because I hadn't met the deductible for the year ($1,000 in personal expenses).
If the lab had been coded as preventive, I would have paid 20 percent, or $65 instead of $325.
If I had known this from the outset, I could have mentioned to my doctor that this was a well visit and that the blood work was not diagnostic. Doctors usually think all blood work is diagnostic, since they use it to diagnose your medical condition. However, if you get bloodwork before you go to the doctor, he isn't diagnosing anything -- it's a checkup.
Insurance is ever evolving, and some big changes are ahead of us. However, this is one change that has already taken place. A few years back, if medical care was preventive, it wasn't likely to be covered by your insurance. Now, preventive care is usually covered by insurance. 
The Affordable Care Act requires health plans to cover specific injections and screening tests without consideration of your deductible. You don't pay a copayment or coinsurance for covered preventive services. A list of the covered services for adults are shown on the website.
Specific preventive services are free for women and children as well, as shown on the link on that page.
Lesson learned. If you go to the doctor for a checkup or well visit, tell the doctor you are there for a well visit for preventive care. The coding can matter to your financial health.