Can I Use My Health Insurance?

One question patients ask frequently is “can I use my health insurance?”  The answer is “it depends”.

Insurance plans are complicated. Just because a doctor is in-network (takes your insurance) doesn’t mean your insurance will pay for your visit, and sometimes insurance pays for a visit even if the doctor is out-of-network (doesn’t take your insurance).

Below is a flowchart to help you determine if you can use your insurance when you see us. You’ll need to know your plan’s benefits (mailed to you or on your insurer’s website). Keep reading for an explanation!

*Most insurance plans cover certain visits before you meet your deductible, such as for checkups and vaccines. Visits for a condition, such as seeing a doctor because you have headaches, are not part of that.

The most common confusion we see with patients is that they didn’t know they had to meet their deductible first, even if they see a doctor who takes their insurance, and they didn’t know their copay could be more expensive than if they had paid without insurance.

If you have not met your deductible, your insurance will not cover your visit, even if you see a doctor who’s in-network (takes your insurance).

For example, say your insurance plan has a $1,000 deductible. You’ve only spent $200 at the doctor’s office so far this year. In this case, your insurance will not cover your next visit, even if the doctor takes your insurance. Your insurance won’t kick in until you’ve spent $1,000 of your own money (met your deductible).

If your insurance plan covers out-of-network provider visits, then you can use your insurance even when you see a doctor that is out-of-network (doesn’t take your insurance)! You may need to file with your insurance company first, then your insurance company will pay you instead of the doctor. Your insurance company has these forms available on their website and we’re happy to help you fill them out.

Finally, sometimes it’s cheaper to pay cash even when your insurance covers you. Many insurance plans make you pay a “copay” at each office visit. If your copay is $45, and the cash price for a visit is $40, then it’s actually cheaper for you to pay cash instead of using your insurance!

If you have questions about your benefits, we’re happy to help! Contact us and we’ll help you make sense of it all.

If you can’t or don’t want to use your insurance for your visit, our fees are very affordable and we offer discounts. See them here.

We provide the same quality care regardless of how you pay. To schedule an appointment, click here or call (804) 745-1605.