One of the most frequent inquiries I receive from members considering trying a new treatment method, seeing a different doctor, or switching medications is, "Is this covered?" And I'm always appreciative when they call to ask before using services so they won't be in for a shock when they receive the bill.
What exactly does "covered" mean?
A service is considered covered if your health plan will cover all or part of the expense. Most of the time, your doctor must be included in the network of medical professionals who accept your insurance. What kind of care you utilize and where you receive it will affect how much your health plan will cover.
You are entirely uncharged for some covered services, like your yearly physical exam at the doctor's office. Your plan covers every expense.
You will need to pay a fee if you need to fill a prescription for approved antibiotics or visit the doctor for an ongoing sinus infection. Depending on your plan type and if you have paid the amount due before your plan may start assisting you, the amount you pay will vary (your deductible).