Who Truly Makes the Decisions
If you have insurance they will review any order and decide whether it is justified by doing a prior authorization. At that time the authorization is done they can do several things,
- Say yes you need this study and we will authorize it, however that does not guarantee payment
- No we will not pay for the prescribed procedure but we will pay for a different procedure and they could require a different provider.
- They could outright deny the procedure.
Let’s Talk Money
Understanding the difference between premiums, copays and deductibles can be confusing; but each of these are different aspects of the insurance.
- Your premium is the amount you pay each month to the insurance company for your coverage. If you fall 30days behind you start your grace period. This means that the insurance company will give you a chance to catch up on your premiums.
- A copayment or coinsurance is the percentage of the insurance company’s contracted fee for service you are required to pay. Usually they are anywhere from 10% to 50%.
- A deductible is the amount of money you must pay before your insurance company will pay for a service. There may be services such as a doctor’s office visit or mammogram that do not apply toward your deductible.
You doctor knows what is best for you but remember you get to have some input into your care.