Health Insurance Coverage: What Does it Mean?

I was told that something is “covered” and then I got a bill for it! That doesn’t seem right. What does it mean if something is covered if it isn’t included in my premium costs?

 

That can be confusing! And no one likes getting an unexpected bill. Let’s see if we can help clarify so you aren’t surprised the next time.

 

To help, we recommended reviewing Deductibles versus Coinsurance to help clarify what an insurance company means by “Cost Sharing.”

So What Does “Covered” Mean?

With that background, let’s clarify the meaning of ‘covered’.

 

Usually, when something is “covered,” it means that the services or procedure qualifies for cost-sharing. This means that, for our Members, RMHP has negotiated rates with the provider, to be lower for our Members, and that our Members’ payments will apply toward their deductibles. As our Member, you will benefit from these negotiated prices, but you will still be responsible for paying your part of the cost until you satisfy your out of pocket maximum.

 

Some “covered” services on your plan have a copay instead of applying toward your deductible. This means that you pay a copay for the procedure or visit, but the procedure or service is free for you and RMHP pays all other fees. Examples of these services include: your annual physical (but not complex blood work!), female annual exams, many children’s vaccines, and much more.

 

Copays for the most common procedures can be found on your ID card.

 

 

Estimate Your Costs

Wondering what you will be responsible for, before you get your procedure done? We know that budgeting is important! As a Member, you can get a close estimate for what something might cost with our online cost estimator. This is available to our Members at no charge, but you’ll need to create an account, if you haven’t already. Have your ID ready and follow the simple instructions.

 

Once you sign in, click on “Estimate Treatment Cost”. It will take you to another site where the tool looks at the average cost of services in your area, and your coverage, to estimate what fees you are responsible for when getting care.

 

Still unsure? Play it safe and check directly with us! Our Customer Service representatives would be happy to look at your health insurance coverage and help you understand/estimate the costs of a procedure or service.

 

 

Other Benefits to Members

Be sure to know what benefits are yours to take advantage of! RMHP Members get many exclusive discounts for health, wellness and local industries, an extensive support network for various conditions like diabetes and pregnancy, and opportunities for giveaways on our social media. You can find details on your profile under “My Healthy Lifestyle.”

 

 

We are proud of the service our teams provide, but we never want to stop improving. Please let us know how we can serve you better!

 

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