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How Health Insurance Works In Colorado Springs

Have questions about how health insurance works in Colorado Springs? You’ve come to the right place. We’ve covered the basics of health insurance for you below. It’s important to understand how health insurance applies to medical expenses, premiums, deductibles, co-payments, and more.

QwikCareMD Urgent Care and Comfort Care Family Practice want to help understand how: 

Private health insurance (such as Blue Cross, Aetna, Cigna) are designed to help people to pay for the potentially crushing charges that can come with illness or injury. Private health insurance policies each have their own rules and requirements.  You will probably have a “Deductible”, a “CoPay”, and “Co-Insurance” that you will be responsible for.  Your Deductible is the amount of money you must pay out-of-pocket for medical services before your insurance will pay ANYTHING.  This means that even though you are insured and even though your provider “accepts” your insurance, you will be required to pay for all visits until your deductible has been met.  There are exceptions to this which will be discussed below.  The insurance company’s contract requires the provider to collect this money from you.

Your Co-Pay is an amount you must pay (regardless of whether or not you’ve met your deductible) prior to seeing your provider.  The amount of your co-pay will generally depend upon what kind of appointment you are having.  Generally a family practice appointment is less than a specialist appointment, which, in turn, is less than an Emergency Room or hospital appointment.

Your Co-Insurance is an amount you must pay (regardless of whether or not you’ve met your deductible) for PROCEDURES (not office visits) which is the difference between what the insurance company believes the visit is worth and what the insurance company actually pays.  Generally co-insurance will be 20-30% of the cost of the visit.

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Here’s an example:

You have a health insurance policy with a $2,000 deductible, a 20% co-insurance, and a $25 co-pay for your primary care provider.  You go to your family doctor and your bill is $200, $100 for the office visit and $100 for laboratory work.

If you have a deductible of $2,000 and have not yet met that deductible, you are responsible for the entire $200.  It is the doctor’s responsibility to collect that $200.  If the doctor fails to collect it, he (and you) are guilty of insurance fraud and are subject to severe penalties.

If you have met your deductible, you owe your $25 co-pay (for the office visit) and $20 (20% of $100) for the procedure (laboratory work) for a total of $45.  Your insurance company should pay the balance.  Again, the provider is REQUIRED to collect this money.  Failure to do so is insurance fraud for you and the provider.

Some coverages are mandated by the Affordable Care Act of 2010 (Obamacare).  Some of the new requirements include:

  • You can no longer be refused insurance (or charged more for insurance) because of pre-existing conditions (such as hypertension, diabetes, asthma, etc).  These would be medical conditions that you have before applying for insurance.
  • You can’t be penalized because of your gender.  Historically women use medical services more than men.  Insurance companies cannot charge women more than men based on gender.
  • Insurance companies may no longer place a maximum on how much they will pay over your lifetime or in a single year.  Until the ACA was enacted, medical problems were one of the primary causes of personal bankruptcy when your insurance payments had reached their limit.
  • The ACA requires employers with over 50 employees to provider medical insurance for their employees.  This requirement has been delayed until January 2015, but even after that, your employer may choose to pay a penalty rather than purchase insurance for employees.

With QwikCareMD Walk-In Urgent Care in Colorado Springs, there is no reason to make an appointment and wait weeks to see your primary care physician or to go to the emergency department for non-life-threatening conditions. You are more than welcome to walk-in and be seen within minutes, not hours.

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Steven Wenrich

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