Five important matters to understand about your health coverage

Understanding your health insurance plan is important to ensure you are getting the most out of your coverage. Whether your medical events are planned or unplanned, your insurance helps to offset the total cost of health care for you and your family. Ridgeview participates in most insurance plans, including Medicare. Here are five things you should know about your health plan:

How do I know what services are covered under my plan?

One of the most common questions people have about their health insurance pertains to what services are covered. Services covered under your insurance means part, or all, of the cost for the service you are receiving will be paid for by your health plan. Every insurance plan covers different doctors, clinics, prescriptions and services.

Your health insurance will have a written summary of the services covered under your plan. If you have any questions or concerns about what services are covered, visit your health insurance company’s website, or call the number on the back of your insurance card to speak directly with a representative.

What does in-network and out-of-network mean?

In-network means the provider you are seeing accepts your health insurance plan. Providers or services that do not accept your insurance plan are considered out-of-network.

In-network and out-of-network services affect the cost of service—seeing an in-network provider means the provider accepts an approved reimbursement amount from your health insurance provider for their services. If you see an out-of-network provider, the cost for their service will likely be higher. Some insurance plans may cover out-of-network services while others may not cover any.

What are deductibles?

A deductible is the amount you pay out-of-pocket for a covered claim before your insurance company starts to pay. However, many plans cover preventive services, like annual check-ups and health screenings, without having to reach your annual deductible first. Depending on your plan, you may have a low deductible or high deductible, which affects how much you pay for your services. Once you have met your deductible, your health insurance provider helps pay for your medical expenses.

Who processes insurance claims?

Ridgeview will process claims on your behalf to all involved health care insurers. Patients are expected to provide current, complete and accurate insurance information to ensure prompt and appropriate claim resolution. If a payment is not received within 45 days from all known third-party payers, the patient will be billed for any remaining balance.

How do I know if the medication prescribed by my provider is covered by my insurance?

To determine what prescription medications are covered under your health plan, search for your plans drug list, or formulary. This list will include tiers that categorize the groups of drugs by cost—there are typically three or four tiers ranging from least expensive drug options (generic drugs) to the highest. Many plans include a specialty drug list for drugs that require prior authorization. Prior authorization is approval of coverage from your insurance company to ensure drug use is appropriate and the most cost-effective therapy is being used.

For assistance verifying coverage and requirements for services received at Ridgeview, call Ridgeview’s Patient Financial Services department at 952.442.8054. Representatives can help answer questions about your account, but do not read or interpret insurance policies. For other questions about your health insurance, contact the number on the back of your insurance card, or visit your insurance plan’s website for more details.