You may use your health insurance multiple times for different reasons throughout the year. A regular checkup at your doctor’s office, a trip to the walk-in clinic for a sick child, or maybe even a specialist visit when you have a health concern.
After these visits, you might notice that your out-of-pocket costs vary depending on what type of care you received. For example, an annual checkup generally costs less than a quick trip to a walk-in clinic. And, both are significantly less than an overnight stay in the hospital.
That can be confusing, right? Going to the doctor is overwhelming enough. And, not knowing how much you’ll have to pay can make the experience more stressful.
Figuring out the world of health care: Mary's story
Let Mary help. She’s a hypothetical 32-year-old, healthy mother expecting her second child. We’ll follow her as she and her family get care throughout the year.
Getting good news: Using health insurance for regular appointments
It’s an exciting time for Mary and her husband, John. Mary found out she was pregnant in mid-February, so she made an appointment for the beginning of April with her ob-gyn.
Throughout her pregnancy, she’ll have regular appointments to make sure she and the baby are healthy. Typically, Mary's provider will bundle all of her pregnancy charges into a single bill after the delivery, but some imaging and lab work — like ultrasounds — may be billed separately.
Mary's experiencing a healthy pregnancy. But, unfortunately, in May, Mary doesn’t feel well. She has a sore, scratchy throat and other flu-like symptoms. She calls her personal, or family, doctor to make an appointment, but he’s unavailable that day, so she heads to a walk-in clinic to get treatment. Mary may have to pay more here than she does at her regular doctor’s office, but she’ll receive care quickly instead of a few days later. Before Mary chooses a walk-in clinic, she logs in to myWellmark® Opens New Window to make sure it’s in her plan’s network.
Dealing with the unexpected: Using health insurance for surgery
In addition to being a doting husband and great dad, John plays on a soccer team for fun. In July, he takes a nasty fall and tears his ACL. John, with the help of his doctor, decides to schedule surgery at an outpatient facility to get it repaired right away. Depending on their plan, Mary and John will likely have to pay their deductible if they haven’t met it yet, plus coinsurance for the surgery. Both amounts go toward their out-of-pocket maximum (OPM).
If Mary and John have a Wellmark BlueSimplicitySM plan, John’s surgery costs can be easily estimated. There’s no coinsurance or deductible with BlueSimplicity — just a copay for the surgeon, facility and anesthesiologist with an ACL repair in an outpatient facility.
myWellmark can help Mary and John estimate the amount John’s surgery will cost in various outpatient facilities nearby.
Going back to school: Using health insurance for annual care
In August, it’s almost time for Mary's 5-year-old son, Paul, to start kindergarten. Before starting school, Paul needs to go in for his annual checkup. Many Wellmark health plans cover preventive exams for children (in addition to annual physicals for Mary and John, and one well-woman exam for Mary) each year in full, so Mary won’t have to pay a copay at the office or be billed later.
Welcoming a new addition: Using health insurance for hospital birth
In early October, Mary delivers a healthy baby girl, Emily, in the hospital. She spends two nights there before going back home. The cost of giving birth in a hospital can vary. If Mary hasn’t met her deductible yet, she’ll have to pay up to that amount, plus any coinsurance that may apply. Remember, she’ll never pay more than her out-of-pocket maximum for the year.
If you have a BlueSimplicity plan, you don’t need to worry about coinsurance or a deductible. All you have to keep track of is your copay for Level 6, which covers hospital visits.
Through it all, Wellmark is here to help
As you can see, Mary and her family have had quite the year when it comes to using their health insurance. Mary paid different amounts for the different services that she and her family needed throughout the year. Whenever she had questions about her health insurance, she logged in to myWellmark Opens New Window. There, she was able to keep track of her health care spending and claims for different services throughout the year, estimate costs for upcoming visits and more.
With myWellmark, you can even sign up to receive all of your Explanations of Benefits (EOB) online. An EOB is a simple recap of how your insurance paid for care you received. It's not a bill, but it tells you how much you'll owe for a visit or service. By getting your EOBs through myWellmark, you can easily track and manage your health care spending by date, provider or patient. Plus, with timely access to online EOBs, you'll no longer have to wait for a bill from your doctor to know if you owe money, and you can confirm your benefits paid as you expected.
Don’t have myWellmark? Registering for one is easy. All you need is your Wellmark ID card, an email address and a couple minutes.