Self-verification
Beginner's guide to medical care & coverage
Facility/Provider
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Contact your potential healthcare provider and ask if the following are in or out of network with your insurance carrier as this impacts the rate at which your insurance will pay a portion of your bill. Sit down with someone who can give you a treatment plan in writing and have a list of questions ready before you go (length of stay, follow-up visits, medications, cost, etc.)
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Charge #1: Any provider(s) who will provide care to you (Physician or Advanced Practice Provider (this includes your Anesthesiologist)
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Charge #2: The facility itself (many forget that this is a separate fee)
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Charge #3: Diagnostic Radiology is usually contracted and will be a separate fee.
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Insurance Carrier
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Contact your insurance carrier and confirm:
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In or Out of Network: Even though your provider said they were in network, confirm this with your carrier along with dates of service.
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Referral: Confirm if you need a referral in order for your benefits to be paid.
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Type of Service: Your carrier may have their own ideas about what is deemed "medically necessary" for coverage. Confirm!
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Prescriptions: You most likely have separate prescription coverage. Don't forget to contact them to ensure that future medications will be covered or if there are generic brands available that will reduce cost.
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EOB: You should receive an Explanation of Benefits after your visit. Review carefully and contact your carrier and the facility if they have not paid their portion. Note that there is a difference between an EOB and a bill.
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