Every time you go to the doctor, you probably use your health insurance. You might pay an up-front copay, which is a fixed amount (i.e. $10) that you may have to pay out-of-pocket when incurring medical expenses. Or, you might not pay until a bill comes in the mail a few weeks later. But, what happens between the time you're seen by your doctor and when you get that bill from the provider's office or Explanation of Benefits from Wellmark?
Let's clarify how your health insurance works behind the scenes, so you can be better informed when receiving health care services. Take a look at how Kim's benefits worked for her when she broke her arm after a recent fall.
Meet Kim. She likes to stay active. She recently fell and has severe pain in her right arm. She immediately goes to the nearest walk-in clinic. When Kim is treated, she meets with a doctor who orders an X-ray. She gets an X-ray of her arm. A radiologist determines she broke her arm. The doctor put Kim's arm in a cast. And sends her home to recover. Then, her insurance goes to work. All charges go to Wellmark to be paid. These charges come from your doctor, the X-ray, lab and other tests, as well as the provider who read the test results. After receiving the claims, Wellmark pays a portion of the cost back to the providers and facilities. Kim receives her Explanations of Benefits (EOB). Since the walk-in clinic processed all the procedures and test on-site, Kim only paid one copay at the time of her visit. Depending on your benefits, you may be responsible for additional costs. Knowing the cost of care, understanding your benefits and talking to your doctor about your treatment options can benefit you. Get started by logging in or registering for myWellmark. Get access to tools and information, like the myWellmark Care Finder, to make sure you save time and money when you need care.