No one likes to be surprised with unexpected costs when
claims or bills come in. Here are some tips to help you sort it out ahead of
time, and hopefully avoid paying anything extra.
Get all of your preventive care, every year. You won’t see
bills for this care because it is included in your plan and doesn’t apply to
your deductible and out-of-pocket maximum. We pay for it because it’s an
important investment in your health. Go to Preventive Health to see what’s included.
When you visit doctors in your network, you will pay the
bills until your deductible is met, and then a percent of the costs until your
out-of-pocket maximum is met, and the charges are the rates we have negotiated
with your network providers.
If you get care from providers who are NOT in your
network, they will charge you rates that are usually higher than our contracted
rates. Even if the claims are submitted to us, we will only pay the amount we
would ordinarily contract for—and you will be responsible for the rest. That’s
called balance billing.
Always be clear with your provider that labs, tests, and services that need preapproval are cleared with us before you have the
procedure. Make Sure You’re Covered
has more detailed information.
Starting Jan. 1, 2020, members of individual and family plans—as well as some group plans—in Washington will get
the added protection of this Act. It closes some gaps, such as getting
emergency care in Washington, Oregon, or Idaho from a hospital or facility not
in your plan network.
The other scenario the Act affects is if you go to an
in-network facility for care, and some of the providers who treat you are not
in your plan network. Under this Act, those providers can’t bill you at
out-of-network rates. If the facility is in your network, you shouldn’t have to
sort out whether any of the care is in or out of network. You should only be charged in-network rates for services such as surgeries, anesthesia, pathology tests, radiology, laboratory, and hospitalist work.
Here are links to information to help you understand what
is in this law:
While it does apply to all individual and family plans, it may not apply to all group plans, so you’ll need to check with your benefits administrator to find out if you’re included.
Note: If you ever get a bill or claim that doesn’t seem right, be sure to contact us and we’ll
look at it with you.
Planning a trip? Be sure to check your options before you take off!
As a Premera member, you can look up costs before scheduling a visit. Sign in and use Find
a Doctor to see providers in your network.
and select Medical Procedure Costs to compare costs for services such as physical therapy, specialist office
visits, and procedures A-Z. Also check your benefit booklet for your coverage.