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The following article was published in Your Health Magazine. Our mission is to empower people to live healthier.
Tracy Soltesz, LAc, MAc
Maximize Your Insurance Benefits
Kunlun Mountain Acupuncture, Inc.

Maximize Your Insurance Benefits

January marks the beginning of many health insurance plans' new “calendar” year, bringing changes in benefits. Health care practitioners may verify benefits as a courtesy. Ultimately coverage is a contract between you and your insurance company. Therefore, it is your responsibility to understand plan limitations and requirements.
Deductibles Plans may require that you pay out-of-pocket before covering any costs. Deductibles start over at the beginning of the year. If you receive care from different specialists, your practitioner may not know the amount applied towards your deductible at the time of visit. He may charge you the full amount of services until receiving word from your plan that the deductible has been met, and will then refund over payments.
If your plan allows you to see out-of-network providers, ask your practitioner for a “super bill” that you can submit. While you won't receive reimbursement for this out-of-network treatment, it will be applied towards your deductible.
Co-pays and Co-insurance A co-pay is a fixed amount that your plan requires you to pay each time you have an office visit regardless of the procedures used. Co-insurance is a percentage of the total fee that your plan requires you to pay. Practitioners are required to bill the plan per procedure, so your co-insurance may change depending on the procedures used that day. Your plan may increase the co-pay or co-insurance at the beginning of the year.
Benefits Benefits may change at the beginning of the year. You may enjoy coverage for services that you previously did not. Your plan might change the visit limitations for covered services. The count towards visits starts at zero with the beginning of the year.
Keep track of your visits, and don't depend on your practitioner for this. Some plans combine visits for different services, for example physical therapy, acupuncture and chiropractic care. Your specialist won't know when you visit another practitioner and therefore won't have an accurate count.
Visit limitations don't account for the level of individual care you may require for your condition. Plans may extend your visit limitation for specific services if you make a request. Most practitioners have cost-effective options for patients who don't have insurance benefits or have reached their plan limit. It is important not to delay receiving proper care simply because your plan limit has been reached. This can lead to more costly or riskier medical intervention.

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