Choosing a healthcare provider is tough enough when you have to consider the quality of care that they provide. But, what if you don’t know who is responsible for making sure insurance covers the care? The answer might surprise you. In this article, we will discuss the responsibility and liability when choosing a healthcare provider for your family, as well as what happens when treatments are not covered by insurance.
When it comes to choosing a healthcare provider, the responsibility and liability fall on you. You have to make sure that anything they do is covered by your insurance or Medicare, so when in doubt, ask! When treatments are not covered by health insurance or Medicare (like dental work), then the costs of care may fall back onto you as the patient.
If there’s one thing we’ve all learned from TV commercials for lawyers – if someone doesn’t know who will pay their medical bills when an accident happens – it can be problematic. In many cases where injury results from negligence on behalf of the doctor but no legal recourse is available due to lack of malpractice coverage, patients end up footing the bill for the injury.
However, when in doubt or if you have any questions about your insurance coverage and how it applies to a specific provider, get in touch with your insurer’s customer service line. They’ll be able to tell you exactly what is covered by your plan – including dental work!
As always we’re happy to answer any of these common queries:
“What should I ask my doctor?”
The three things that are best answered upfront when picking out a doctor are usually related to fees (are they taking new patients? What will this cost me?), credentials/education/training (do they specialize in anything?), and their location relative to where you live or work. When does lunch break start at the hospital?
“What should I ask my dentist?”
The first questions to ask your dentist will be related to their fees, what they offer, and if they take new patients. You’ll also want to check for any restrictions on insurance coverage (i.e., does the clinic do orthodontics?) as well as find out when lunch break starts at your dental office!
“Is everything covered by insurance?”
No, not all treatments are included in every plan – but this is something that can usually be determined with a quick call or chat with customer service. This includes prescriptions (it’s always important to know how much you have left), eyeglasses, vision care, and mental health services which may require authorization from your insurance provider.
“What are my options when I don’t have dental coverage?”
If you’re facing a financial crisis, one option is to apply for Medicaid or other public health care programs – although it’s best if you can start by contacting the federal and state agencies that oversee these types of programs. Other considerations may be asking friends or family for help (or even working out payment plans), saving up until you can afford more treatment, and finding free clinics in your area who offer basic services like cleanings.”
“How do I find out what medications will cost without insurance?”
It is important to know how much medication has been prescribed before discussing prices with your pharmacy. If you need assistance getting prescriptions covered, contact an organization such as the Partnership for Prescription Assistance (PPA).
“How do I find out what my copay will be?”
“Ask your doctor or other healthcare providers what your co-pay is when you are first prescribed medication. It’s also important to ask about possible discounts if you have insurance coverage.” When filling a prescription, always check with the pharmacy before leaving which date and time it can be picked up in order to avoid late fees.
“What if I don’t have insurance? What do I need to know?”
In the case of emergency care, you will not be asked about your ability to pay when seeking treatment. However, in other instances, it is important that you ask upfront how much a procedure or medication would cost before making an appointment. Without sufficient funds for payment, some providers may turn away patients without health insurance coverage with only low-cost options available at nearby clinics like Planned Parenthood and community centers. You can also find out which medications are covered by public assistance programs such as Medicaid and CHIP (Children’s Health Insurance Program) through the Medicare website.”
