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Understanding Your Health Insurance

Posted May 09, 2019 in Insurance

Insurance is confusing, especially if you aren’t around it all day, every day like we are. Our billing specialist took the time to educate the staff here at Mountcastle Plastic Surgery so we can answer questions patients may have about their insurance/out of pocket costs.

Keep in mind every insurance plan is different but first we start with collecting your personal and insurance information. Then we contact your insurance and pull your specific plan benefits. Typically an insurance plan has a deductible, coinsurance, out of pocket max, and sometimes a co-pay.

Some insurances require a referral from your primary care doctor before visiting specialists. These plans usually have the letters HMO on the card or have the primary care doctor’s name. If you have Cigna Connect or Tricare Prime you will need a referral. Dr. Mountcastle is NOT in-network with Kaiser (we do accept Kaiser Multiplan) or out of state Medicaid.

Your deductible is what you are 100% responsible to pay. Then once you meet your deductible you only pay a certain percentage, which is called the coinsurance. The out of pocket max is the amount you accumulate from paying the coinsurance and once you have met that max your insurance will pay at 100%.

For example, say you have a $1500 deductible, 20% coinsurance and $3000 out of pocket max. First, you will have to pay $1500 out of your own pocket, once that is met you will only pay 20% of your medical bills. After you reach $3000 by paying 20% of your medical bills then your insurance will cover you at 100%.

At Dr. Mountcastle’s office, we collect your insurance information and get your “estimated out of pocket cost” which is the estimated amount you will owe to the office. After you pay that you will not receive a bill from us. Most patients appreciate that so they can be aware of what they will be owing and can plan accordingly for their visit with Dr. Mountcastle.

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