Do a New Year Review

Get to know your health care coverage.

The start of a new year is a great time for people to review their health care coverage. It’s always a good idea to know what their plans cover because even plans with the same name from the same company can change from one year to the next.
“It’s important to review your benefits for the coming year,” stresses Crystal Menard, patient coordinator at LAD imaging in Deltona. “For example, a test that was covered at one hundred percent last year may not be covered at one hundred percent this year. Or an exam that applied to a co-pay may not be related to a co-pay anymore. It may go toward a deductible, or there may no longer be a co-pay associated with that particular exam.
“When starting the new year, it’s very important for you to be familiar with your policy – what has stayed the same, what has changed and how any changes are going to affect you.”
Patients need to understand their coverage before they arrive at a physician appointment or a facility for testing. Otherwise, they may be surprised to find that the amount of a co-pay has changed, a co-pay is required when none was before or another change has occurred that they were not expecting.
“LAD imaging believes a patient’s health comes first,” notes Crystal. “Our staff understands that, oftentimes, patients are reluctant to make appointments because they feel their out-of-pocket responsibility, whether it’s a co-pay, coinsurance or deductible, will be out of their budget.
“If you know your out-of-pocket costs beforehand, you can be more proactive with your health. It can help you budget for the exams you need and prioritize the most important exams first. Then, there are no surprises when you get to the doctor’s office or health care facility. Knowing what to expect is half the battle.”
Being familiar with an insurance policy can also lead to getting the most out of its benefits.
“Your doctor may have recommended an exam, but you’ve been putting it off because of out-of-pocket costs. Then you read your insurance plan and discover that it now covers the service. If you hadn’t taken another look at your plan, you wouldn’t have known this,” explains Crystal.

Deductibles Defined

Crystal recommends that patients pay close attention to policy deductibles and how much is being met with each medical service. Most deductibles start at the beginning of the year. That means they reset to the full amount. For instance, if the deductible is $2,500, the patient will need to pay that much out-of-pocket for covered medical services before the insurance company begins to pay.
“If you have a deductible, keep track of how much you’ve paid toward it, especially if you have a lot of exams or doctor visits,” emphasizes Crystal. “You may find that you’ve met the deductible sooner than you think.”
A common misconception is that deductibles must be met all at once. And when patients mistakenly believe costs of a test will be high because a deductible is owed, they may delay a recommended exam.

“If you know your out-of-pocket costs beforehand, you can be more proactive with your health. It can help you budget for the exams you need and prioritize the most important exams first.” – Crystal

For example, a patient who has a $500 deductible and needs a medical study may believe that $500 will be required out-of-pocket immediately. However, when insurance companies contract with providers, they set “allowable” rates for services. The allowable rate for a medical test, such as an MRI, may be less than the deductible, which means the patient will owe less.
To learn more about their specific insurance plans, individuals can refer to the summary of benefits provided by the insurance company at the start of the plan year.
“The companies generally also provide a website link so their members can go online and see which exams and procedures are covered,” notes Crystal. “They can find out details such as what deductibles, co-pays or coinsurance costs apply as well.
“The other option is to look on the back of your insurance card for the customer service or member services phone number. You can easily call the customer services representative and say, Hello, this is my policy number and these are the things I have done routinely. Can you tell me what exams are covered and if they are subject to a deductible?

Going the Extra Mile

LAD imaging is a fully accredited outpatient center that serves its community with a wide range of diagnostic imaging tests. These include traditional x-rays, computed tomography (CT), high-field MRI and magnetic resonance angiography (MRA), ultrasound (including four-dimensional OB images), vascular studies, echocardiograms, bone density testing and mammography.
LAD imaging’s singular mission is to produce high-quality diagnostic images so doctors have the best information available in designing a treatment plan for their patients. Its vision is to create a pleasant, convenient experience for both patient and prescriber.
The staff at LAD imaging goes the extra mile to help patients understand fees and how to work within their budgets. The center participates in most insurance plans, including Medicare and Medicaid. Self-pay patients and those with out-of-pocket responsibilities are often pleasantly surprised to learn that LAD imaging has the most affordable fee structure in the area and has a payment plan available.

Patient Responsibilities

When it comes to insurance authorizations, the staff of LAD imaging is as proactive as they ask their patients to be regarding their health care.
“We verify all of our patient’s insurance a day or two before they come in,” describes Crystal. “We contact the patient to tell them how much of the cost they will be responsible for. Some higher-technology exams, such as MRI and CT scans, might require preauthorization or referral. If they need an authorization, we will call their doctor’s office for them to obtain it.”

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