Health is a big concern right now. Health insurance is intended to give you some peace of mind but often people don’t understand how their health insurance works. Premiums are costly – we believe it is SUPER important to know how to best use your health insurance so that you don’t find yourself paying more for services than you need to. For example, do you know how much you would be responsible to pay if you needed an MRI? Typically you will have to pay your full deductible first, before your insurance carrier starts covering any of the cost of your MRI. It is important to also note that most insurance carriers will DENY your MRI if you do not get it pre-approved! BIG mistake that can occur. Don’t rely on your doctor’s office to do that for you – it is your responsibility, not theirs. Often your doctor’s office will do the pre-approval process for you, but always check with them to make sure they did.
Here is a scenario to help you understand how an MRI would be covered: Susan is hiking down a mountain and trips. She hurts her knee and now her doctor is suggesting she get an MRI to see what is going on. Susan is on a $2000 deductible medical plan that has 80/20 coinsurance and a total out-of-pocket max of $6000. Her doctor’s office has contacted her insurance carrier and received pre-authorization to schedule her MRI. The MRI is going to cost a total of $2500. Susan is going to have to pay her full deductible of $2000, leaving $500 left on her MRI bill. Now that she has met her $2000 deductible, coinsurance kicks in and she will be responsible for 20% of the remaining $500, or $100, and her insurance carrier will pay 80% of the remaining $500, or $400.
What if the MRI revealed that Susan has a torn ACL and needs to have surgery? Remember, she has already met her $2000 deductible but her total out-of-pocket max is $6000. Let’s say her knee surgery will cost $35,000. Of the $35,000 bill, Susan’s insurance company is responsible for 80% of that cost and Susan is responsible for 20% of that cost until Susan has spent a total of $6000. With her MRI Susan spent a total of $2100 so she only has $3900 left to pay for the calendar year before she hits her total out-of-pocket max of $6000. Of the $35,000, Susan will pay $3900 and her insurance carrier will cover the remaining $31,100. Clear as mud?
ANI is an independent insurance agency which means we represent hundreds of carriers. We have the privilege of being able to shop around to find companies and/or individuals the VERY best carrier/plan to meet their needs. Moda Health is just one of the carriers we represent. They have done a great job creating a video that explains how health insurance works. Please take a moment and watch this. We want you to remain healthy and if you do need to visit a doctor, we want you to understand how your insurance works and what your financial responsibility will be. Have specific questions? Please do not hesitate to contact us! We are here for you – 907-562-3020.