"Is this covered?" is one of the most mutual questions I get from members wondering about seeing a new doctor, changing medicines or trying a new treatment option. And I'grand always happy when they call and enquire me before using services to avoid an unpleasant surprise when they get the bill.

Questions to ask to figure out if it'south covered:

What does "covered" mean anyway?

If a service is covered, it means your wellness plan will pay for some or all of the cost. In most cases, your doctor besides needs to be on the list of doctors that take your insurance, chosen a network. How much your health programme pays for depends on what type of care you employ and where you get it.

For example:

  • Some covered services are completely gratis to you, like going to the doctor for your almanac exam. Your programme pays everything.
  • For others – like seeing the physician for a lingering sinus infection or filling a prescription for covered antibiotics – you'll pay a fee. The amount you pay will be different depending on the blazon of program you have and whether or non yous've taken care of the amount you have to pay earlier your programme starts helping you (your deductible).

HealthPartners members: Sign in hither to cheque your deductible.

To get the biggest bang for your buck, utilize services your health plan covers whenever possible.

How do I know what's covered?

Every plan – even plans through the aforementioned insurance company - covers different doctors, clinics, prescriptions and other services. This is oft because in that location are dissimilar types of plans to choose from. Some members are surprised to learn that their plan covers things they didn't expect, like their chiropractor visits and pumps for breastfeeding moms. Check that the care you want is covered – and the amount you'll have to pay – earlier you make an appointment.

Here are four places to go for info:

  1. Your Summary of Benefits and Coverage: Sign in to your online business relationship through your insurance company, and look for a link to your programme'southward Summary of Benefits and Coverage, sometimes called an SBC. This is a standard certificate that all plans are required to accept. It lists the services the plan covers and how much (see a sample SBC).

HealthPartners members: Your My plan tab summarizes this information for yous. Sign in now.

  1. Your doctor search tool:Sign in to your online account, and look for a link to your plan'south network, provider or doctor search tool. Different plans encompass different doctors, specialists and clinics – called the programme's network. Cheque that the doctor you want to see is covered.

HealthPartners members: Click here to see the doctors your plan covers.

  1. Your list of covered drugs: Sign in to your online account, and look for a link to your plan'southward preferred drug list. All plans have a listing of the prescriptions they cover. Search the list to brand sure the prescriptions you need are included. Some plans also offering a calculator tool to assist you find the lowest prices on prescriptions from specific pharmacies or in unlike quantities.

Image: Health blog - ! Tip

Sometimes y'all can go fewer pills at a higher dose and split them yourself to save coin. Always talk with your medico about this option and the correct fashion to do this.

  1. Call or e-chat with a fellow member services representative:At that place's no such affair as a silly question. If you accept any questions about what your plan covers, call your insurance company. Member services representatives are there to answer exactly these types of calls. They can tell you whether a doctor, prescription or service is covered and how much your insurance will pay.

Yous're reading the "Getting Started With Your Plan" serial.

Have a health plan but non sure what to do next? This series can help you get started.

Role 1: I picked a new plan for this yr...now what?

Part 2: How to figure out what your health insurance program covers

Function 3: 8 questions to ask earlier setting up your HSA