TheCo-pay [$5 to $15] called for in some health care policies is designed to make you think twice before you make Doctor's appointment. Experience shows that it reduces the number of Doctor visits. If there is no co-pay, patients see a Doctor for very minor complaints----leading to waiting lines for patients with more serious problems. [this occurs in nations with total coverage, which means all visit are free.]
Authorization is the term that applies to procedures ordered by your Doctor when you need X-rays, lab tests or surgical operations to cure your illness.The Doctor has to get pre-permission from your insurance company to cover the cost of what the Doctor orders for you. Without prior authorization[permission] you would have to pay the bills. It's really a form of health care rationing because the insurance company has the right to deny the authorization. In some insurance companies non-professionals [some one other than a Doctor] make the decision. As a result injuries and deaths have occurred because of authorization denials. Some States passed laws requiring that only Doctors be allowed to act on authorization requests.
What is a "Deductible"---that's the amount of money you have to pay "out of your pocket" before your insurance carrier will start paying your health care bills. The higher the deductible the less your insurance premium will cost. The high deductible is no more than a higher premium---part was paid to the insurance company and part is paid directly to the health care provider [Doctor, Hospital, Drug Store]. Either way you pay, unless you take better care of yourself and use the health care system as little as possible. That's the only way to save money with a high deductible policy
The agent who sold me this policy said it would cover anything I needed, why are you telling me that I have to pay for that test?
Answer...be sure you understand what "complete coverage" means in the insurance policy being offered to you. Don't sign anything until you get a full explanation. Those catch phrases "complete coverage" and "all your necessary tests" mean different things to different insurance companies and be especially suspiciouis when they say "whatever your Doctor orders for you". Too many policies limit what the Doctor can order for you. Read the fine print and ask questions. You'd do that if you were buying a car a refrigerator, for the expensive stuff, why not for your health insurance.
What is an MSA [Medical Savings Account] also referred to as a medical IRA?...It's a legal tax deductible health care insurance program set up by the federal government that allows individuals or families to insure themselves when it comes to their health care. Each year you can put a designated amount of money, tax-free, [$1500 for an individual,$3500 for a family] into trust account like an IRA. This money can only be spent on health care but allows you to get that care from any Doctor you choose. What's not spent, in any given year, can "rollover", tax-free into your IRA to be used when needed [accumulating interest in the account is also tax free]. You only need to buy a high deductible health care policy [sells for about $1800 to $2000 a year] that covers expenses if you use up all the money in your IRA fund. It's designed to allow people to take care of themselves and to use the Doctors and facilities that they choose. After the age of 65, the money in the IRA can be used in any way you desire.
. Why hasn't the insurance company paid my bill? Didn't you send in my claim?, the insurance company told me you hadn't sent them anything?----This is a common scene in a Doctor's office. The real story is that the claim sent in was lost, trashed or denied without anyone being notified [it's always somebody else's fault] ---some insurance companies don't pay on the first request and we suspect they hope that the Doctor's office won't bother to bill a second time. Janitor's have noticed that when they sweep up at night they find claims in the trash. The government admits that a high school education is all that is required for claim review. Many managers in the Doctor's office would not be surprised to hear that.
See Commonly Used Words Section for additional answers