Here are some examples of frequently asked questions regarding medical and prescription coverage.
What is the difference between copays and co insurance? A copay is usually a set dollar amount paid to a doctor, specialist, etc. for a service. Whereas, co insurance is a percentage i.e. 10, 20, 30, percent of the bill per visit or service.
What is the Coverage Gap or "Doughnut Hole"? This refers to medicare prescription drug coverage or part D drug coverage. The doughnut hole or gap is reached when a person's drug coverage limit $2850, total prescription costs have been exceeded, at which point the cost of prescriptions will increase to 47.5% for name brand medications and 72% of the drug cost for generics until the true out of pocket of $4550 is met.
What type of plan do I have? Most plans are either PPO (preferred provider organization) or HMO (health maintenance organization). PPO's generally use a network of doctors, specialists, hospitals, etc, but you can see providers out of network, usually at a higher cost to you. HMO's use network providers and require referrals from a primary care physician and do not cover out of network unless it is an emergency or urgent situation.
Please call us at (800)575-9594 or (404)944-7986 with any questions about your coverage or claims.
If you have Medicare or Individual major medical, the claims process can be frustrating and time consuming, and not to mention expensive.
If you have questions regarding medical or prescription drug coverage, call us we can help make sense of the claims process.
We can help you save your money on claims.