Co-Author: Roni Elder
Talk about a headache. Feel like I need to go to the doctor after thinking about this topic.
One of the most complicated things that we deal with is medical insurance, yet it’s something we should be versed in. Our health and our finances are some of the most important aspects of our lives. So why does it have to be so complex? Our 3 things to know about your insurance will break down specific terms and how the ENT Institute relates to your benefits.
Now, here are the 4 things to know about your insurance. Ready?
#1. Not everything is covered by insurance:
Although there are a lot of things covered by insurance, there’s always procedures or devices that are not. For example, at the Hearing Center, our hearing aids are an out-of-pocket expense. For other procedures, make sure to contact your insurance to ensure you’re covered. Without that knowledge, you might receive an unexpected bill.
#2. Some things are free, regardless of insurance:
One thing that doesn’t require insurance is the flu vaccine. If you’re worried about not catching the flu but paying out-of-pocket, then worry no more! Many places, even Rite Aid, CVS, and Walgreens carry vaccines.
#3. In-Network and Out-of-Network:
With every insurance plan, certain providers will be out-of-network. Meaning, you won’t be covered there so you’ll pay out-of-pocket prices. For certain insurances such as United Healthcare, there are apps that will show you exactly which providers are under their blanket. Some policies have reduced out-of-network benefits. Meaning, the insurance companies pay a smaller amount which makes the payer responsible for a higher amount. Most insurance cards have a phone number on the back to get that information. To find out what insurances the ENT Institute takes, visit our Patient Information page.
#4. Difference between HMO, PPO, EPO, and POS:
Signing up for health insurance through an employer can be stressful. All the options just confuse the process and many of them are hard to understand. To clear things up, here’s a short-list and basic description (information gathered from Policy Genius):
- HMO (Health Maintenance Organization)- In this plan you’ll be tied down with one specific physician. Meaning any specialist you want to see requires a referral. Does not cover out-of-network.
- PPO (Preferred Provider Organization) – This one’s generally a tad more expensive than HMO, but you don’t need referrals and can go out-of-network for a higher cost.
- EPO (Exclusive Provider Organization) – This is a hybrid of the previous two where you don’t need referrals but it also doesn’t cover out-of-network.
- POS (Point of Service) – This is a lower cost plan, but with fewer choices in the long run.
These 4 things to know about your insurance are just the basics. Doing more research will save you a lot of time and headache. Don’t be surprised by those unwanted bills. Enjoy transparent pricing with the ENT Institute. Call 770-740-1860 for same-day and Saturday appointments. And don’t forget, we do take WellCare!