How Properly Using Your Health Policy Reduces Medical Bills
Use of PPO Networks Reduces Medical Bills
She asked why she was getting a big bill from the doctor. Wasn’t her health plan company supposed to pay for it? “I thought having a health plan would reduce my medical bills!”
It’s a common question, especially from people who do not go to the doctor very often. How does a PPO network work with your health plan? How does it save you money? It’s simple really.
Go to a doctor in your PPO network – get a discount.
Do NOT go to a doctor not in your PPO – pay retail. Your choice.
Here’s a basic outline of the way it works when you go to a doctor that is in your PPO network. Let’s use the following example.
- Your health plan is from X-company. They include the CIGNA PPO network for your plan.
- When a doctor signs an agreement with CIGNA to be in their PPO then that doctor is agreeing to discount the cost of their services to anyone having a health plan that participates in the CIGNA PPO network.
- When you go to a doctor in the CIGNA PPO the doctor sends the CLAIM to your health plan company.
- Upon receiving the claim your health plan company discounts each service listed on the bill based upon the amount of discount agreed upon by the doctor.
- Your health plan company sends you an EXPLANATION OF BENEFITS (EOB) showing several things such as:
- the normal cost of the services you received
- the discount by the PPO
- the amount the health plan company paid to the doctor, if any
- the amount you owe
- You compare the doctor’s bill with the EOB from the insurance company to ensure you are being correctly billed and that you are getting discounts
A Tip on Tracking Doctor Bills
When I get a bill from ANY healthcare provider I hold on to it until I receive the EOB from my health plan company. Among other things, I want to see what services were charged and how much of a discount I received. The EOB also tells me how much was paid to the doctor by my health plan and finally how much I owe. The amount that I owe is shown on the EOB as “patient responsibility.”
Missing an EOB?
If you don’t get an EOB then it’s either because the doctor’s office either has not submitted the claim OR the CLAIMS DEPT told them to correct it and re-submit it.
You see, by law the health plan company must complete a claim in 30 days UNLESS there has been a problem with the claim, such as the claim having errors from the doctor’s office or missing vital info.
- A PPO network is not an insurance company. It is a separate organization.
- The discount applies even if you have not reached your deductible
- The doctors are obligated by contract to give you a discount
There are probably other things that may cause you to have questions about insurance and about health plans specifically. Hey, if it wasn’t complicated we insurance advisers wouldn’t have to spend hundreds of hours studying it.
Feel free to call or email me with questions or just leave a comment in the box below.