My health insurance coverage used to be simple. When I started working, there was little or no premium charge. I didn't have to worry about in network or out of network. I paid when I visited and it was all covered. Over time, it evolved into higher premiums with copays and coinsurance.
Fast forward to today. I now have a 1 inch thick book explaining benefits and my responsibility. I have copays, coinsurance, deductibles and varying coverages. Sometimes, I don't have a good idea of what is covered completely or only limited in coverage. Some areas seem to be 100% coverage but turn out not to meet all the conditions. Some times the benefit is more that I expected.
Sometimes the provider doesn't have a good grasp of what is covered and when insurance doesn't provide coverage.
Yesterday, I spend the whole morning reviewing and understanding the coverage I have for one visit. The previous afternoon, I was in discussion with the provider's billing department discussing why the visit wasn't 100% covered.
Now I have a better understanding of Medicare Annual Wellness Visit coverage and Annual Physical Exam coverage, but it shouldn't take 2 half days worth of effort and phone calls.
This is not financial advice. Please consult a professional advisor.
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