For many medical exams, tests, procedures and surgeries, patients must pay a deductible, coinsurance or copay (or a combination of the three). Most health insurance policies, however, provide full coverage for preventative care -- which means patients don’t need to pay anything for these services. Sometimes patients are billed for preventative services, though. If you’ve been billed for a preventative service, here’s how to find out if your insurance plan will cover the charges.
(Preventative care doesn’t usually include joint replacements, physical rehabilitation or treatment at a tick-borne disease center. Routine check-ups, colonoscopies, mammograms and similar procedures typically are considered preventative.)
Step 1: Determine Whether You Were Billed
Whenever you receive a paper resembling a bill from either your doctor or health insurance provider, you should first make sure it is a bill. Doctors’ offices and health insurers may send statements to patients that resemble bills but are actually just explaining what services the insurance policy covers. Statements usually say “this is not a bill,” but sometimes whether the paper is a bill isn’t stated so clearly.
(If you receive a paper from us at Peconic Bay Medical Center and aren’t sure whether it’s a bill or statement, feel free to contact our billing department about it. We’d be happy to explain the paper to you.)
Step 2: Determine Why You Were Billed
Assuming you were sent an actual bill, the next step is to figure out why your doctor billed you. Specifically, you should find out if they first submitted the charges to your insurance provider.
If your doctor doesn’t have your current insurer on file, they might not have submitted the charges. In this case, update your insurance information and ask the office to submit the charges to your insurer. They should be happy to, as long as they accept the insurance policy.
If your doctor doesn’t accept your insurance, you may need to submit the charges yourself. You can call your insurance provider to find out how to submit charges.
Step 3: Pay Any Charges You’re Responsible For
Most of the time, you won’t be responsible for any charges after your preventative service has been properly submitted to your insurer. If there are any issues with your coverage, though, you may have to pay the bill in full. For instance, if you forgot to pay your premium, your coverage may be temporarily suspended until you pay your past-due premiums.
Step 4: Request Reimbursement
If you have to pay for your preventative care, you can submit the charges to your insurer for reimbursement. Simply requesting a reimbursement doesn’t guarantee that your insurer will pay all of the charges. Whether you’re covered is determined by your policy’s terms and conditions. Submitting any fees you pay to your insurer will, however, make sure you’re reimbursed for any charges that your insurer should have covered.
There are exceptions, but most patients aren’t responsible for paying for their preventative care. If you go through these four steps, it will provide preventive measures from paying more than your policy states you need to for any preventative services you receive -- even if you’re initially sent a bill.