Overland ParkBlog
March 5, 2024
Health insurance primer
Health insurance works by providing financial coverage for medical expenses incurred by the insured individual. When someone purchases health insurance, they pay a premium, usually every month, to the insurance company. In return, the insurance company agrees to cover a portion of the insured individual’s medical expenses, depending on the terms of the policy.
Some common terms associated with health insurance that may not be well understood include:
1. Premium: The amount paid by the insured individual to the insurance company for coverage.
2. Deductible: The amount that the insured individual must pay out of pocket for covered services before the insurance company starts to pay.
3. Copayment (or Copay): A fixed amount that the insured individual pays for covered services at the time of receiving care.
4. Coinsurance: The percentage of the cost of covered services that the insured individual is responsible for paying after the deductible has been met.
5. Out-of-pocket maximum: The maximum amount that the insured individual is required to pay for covered services during a policy period, after which the insurance company covers 100% of the costs.
6. Network: The group of healthcare providers, hospitals, and facilities that have contracted with the insurance company to provide services at a discounted rate to insured individuals.
7. Preauthorization: The process of obtaining approval from the insurance company before receiving certain types of medical care or services.
8. Exclusion: Specific medical services or treatments that are not covered by the insurance policy.
9. In-network vs. out-of-network: In-network providers are those who have contracted with the insurance company to provide services at a discounted rate, while out-of-network providers do not have such agreements and may result in higher out-of-pocket costs for the insured individual.
10. Explanation of Benefits (EOB): A statement sent by the insurance company to the insured individual explaining how a claim was processed and detailing the costs and payments made.
For the visual learners among us, here is a short YouTube series that explains health insurance in a very concise manner.
We are always available to walk through any insurance, or cash-pay, questions you might have when it comes to services here at TruMove.
And for the podcast lovers among us…you can find the Cure and the Curse podcast on FB.
