IS A DOCTOR’S OFFICE OR MEDICAL FACILITY ENTITLED TO YOUR SOCIAL SECURITY NUMBER?

Am I required to give my social security number to my doctor?

The answer to this is NO.

While it is helpful for providers and facilities to have your social security number, it is not something that they need for billing purposes. Insurance companies identify you by the number they supply as your identification number, along with your date of birth and address.

Why do doctors ask for social security number?

At one time, all health insurance ID numbers were social security numbers, but that changed many years ago as private health insurance companies abandoned this practice in response to the rise in identity theft. In fact, currently only Medicare uses your social security number as your ID, and that practice is rapidly coming to an end. By 2019, Medicare must begin issuing Medicare cards with new non-social security number identifiers.

What To Do If Your Doctor Asks For Your Social Security Number

When registering at a hospital, lab, medical facility, or doctor’s office, DO NOT provide your social security number, even when it is listed as a question on the in-take forms. Many facilities still ask the question hoping that patients will provide the response. But the item should be left blank to protect you. If pressured for the answer by a staff member, simply inform them that your social security number is not required for billing or clinical purposes. If necessary, ask to speak to a supervisor who should be well aware of this.

Why you shouldn’t give your doctor your Social Security number

Medical providers have access to a significant amount of personal information that, in the wrong hands, could compromise your identity and your credit. Most of this is needed in order for you to receive care. However, they aren’t entitled to everything. Withholding social security information is your right and it is one way for you to help protect yourself against identity theft.


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WHY DOESN’T MY DOCTOR KNOW WHAT MY INSURANCE COVERS?

How do I know if my doctor is in network?

You go out of your way to ensure that any doctor you see is in your network. You pay your copay before you even see the doctor. Why, then, do you end up receiving bills that you weren’t expecting for services not covered by your insurance? Why doesn’t your doctor inform you that he/she will be performing tests that might not be covered by your policy?

Understanding what your Health Insurance Plan covers

The short answer is that even as an in-network provider, your doctor does not know exactly what your insurance will or won’t cover until the claim has been submitted to your insurance and it has been processed. While it would seem only right that all services provided by an in-network should be covered by your policy, it isn’t as straightforward as that.

Understanding your health coverage policy

In reality, each insurance company has tens if not hundreds of policies that it makes available to individuals as well as businesses. Each one is priced according to the covered benefits. Typically the more services that are covered in a plan, the higher the premium. But even within highly comprehensive policies, there is a growing list of non-covered services. These could be immunizations, tests, and certain procedures that the insurer will not cover as part of the policy. Or the insurer could limit coverage for certain services to particular diagnoses or age of the patient: these services, therefore, could be covered in some instances and denied in others.

Why isn’t my insurance covering anything?

Given the breadth of options for coverage, it is virtually impossible for a doctor to know definitely if a particular service will or won’t be covered under your policy. Insurance companies will not provide that information to a doctor in advance of providing the service and submitting the claim. However, they will supply that information to the member in advance of receiving these services.

What are procedure codes and diagnosis codes?

It is in your best interest to ask your doctor, in advance of care, what procedure and diagnosis codes he/she will be billing for services provided to you. Contact your insurance company and explain which doctor will provide the services and ask them to review the codes against your policy benefits to let you know what, if anything, you will be your financially responsible to pay. They will be able to determine not only which codes won’t be covered, but also, what codes that are covered might be subject to a deductible, requiring a payment from you.

Patients are ultimately responsible to know and understand the benefits of your health insurance.w


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What is a copay?

What is a copay?

Copays, once simple and straight forward, are now becoming more complex. Not only are there different copays for different places of service and service providers (office visits vs emergency room visits; specialist vs primary care), but recently more insurance companies have instituted gradations of copays tied to quality assessments of physicians in their networks. Typically these quality designations are based not only on the quality of their clinical care, but also on the cost of that care to the insurance company.

What is a copayment and how is it determined?

In order to incentivize their members to utilize the quality providers in their network, insurers are either removing the patient’s responsibility for the copay entirely or reducing the cost of that copay if members use one of the quality physicians in the network.

What is my copay?

Check your plan to see if copay savings are available to you via quality physician networks. Your insurance ID card might detail those copays. If not, contact customer service for your plan to see if you can access these savings.


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SAVE MONEY ON DOCTOR AND HOSPITAL BILLS WITH A HEALTH SAVINGS ACCOUNT FOR QUALIFIED MEDICAL EXPENSES

What is a Health Savings Account or HSA?

With the rise of high deductible health plans, employers and their employees have begun to increase their utilization of health savings accounts (HSAs) to address their obligations for medical expenses. If an HSA is an available option for you, you should take it, and here’s why.

Health Savings Account FAQ

Health savings accounts allow you to ear mark a designated amount of your pre-tax salary for use to pay approved medical expenses. Given that most people are now subject to higher deductibles, copays, and coinsurances, it is very helpful to ease the burden of financial responsibility for these costs by paying for them with HSA funds. While there is little you can do about changing what you owe, at least you can cushion the blow by paying your medical bills with pre-tax dollars.

Health Savings Account Rules

In addition to deductibles, copays, and coinsurances, HSAs can pay for non-covered medical services, especially out-of-network services, as well as prescriptions, medical devices and some over-the-counter medications. Often employees are given a credit card for access to those funds, making the process easy and seamless. For a complete list of covered expenses, speak to your HR benefits department.

Health Savings Account Qualified Medical Expenses

Examples of qualified expenses for HSA according to the IRS

Use HSA for Acupuncture
Use HSA for Alcohol and drug addiction treatment
Use HSA for Breast reconstruction surgery
Use HSA for Dental treatment
Use HSA for Diagnostic tests and devices
Use HSA for Doctor’s visits
Use HSA for Prescriptions
Use HSA for Eyeglasses, contact lenses and exams
Use HSA for Fertility enhancements
Use HSA for Hearing aids and batteries
Use HSA for Operations/surgery (non-cosmetic)
Use HSA for Nursing services
Use HSA for Physical therapy
Use HSA for Psychiatric care
Use HSA for Smoking cessation

 

How to use an HSA , Health Savings Account or Health Spending Accounts

One point of warning: be sure to review all medical bills for their accuracy BEFORE providing payment. While the cost to you is minimized by using these pre-tax funds, you want to ensure that the services have been billed correctly and processed completely before you make payment. Be sure to enlist the help of a medical claims advocate who can provide a thorough review of your medical bills. These patient advocates often identify billing errors that result in reduced medical bill costs.


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Where should I go for an x ray? Hospital, urgent care, or independent radiology practice?

Where should I go for an x ray?

You need an x-ray. Do you go for an x ray at a hospital, urgent care, or a radiology practice? It’s a tough question and if you are like most people, your knee-jerk reaction would be to go to the radiology department of your local hospital for the procedure…and that decision could cost you more money than necessary. Here’s why.

How much do x rays cost with insurance?

Insurance companies pay doctors and facilities through negotiated contract rates. The larger the organization, the greater their bargaining power and therefore, the higher their contracted rates for the services they provide.

If you need an x-ray or other radiological procedure, the costs for any given procedure will vary by facility. Typically, procedures will cost more at a hospital than at an independent radiology practice, and the contracted rates will be higher at the hospital as well. This distinction is important, particularly when a deductible comes into play.

Chest x ray cost with insurance after deductible

If your health insurance has a deductible, you are responsible to pay the full amount of that deductible before your insurer pays anything. If you need an x-ray while you still have a remaining deductible to pay, in essence you will be fully funding that x-ray yourself: the facility will bill your insurance company, the insurer will approve it at the contracted rate, the insurer will apply the contracted rate for the procedure to your deductible, and you will receive a bill for the full contracted rate from the facility for that procedure. The higher the contracted rate, the more you are responsible to pay.

How much do x rays cost at urgent care?

To ensure the lowest cost for the procedure, you need to do some research first. Ask the doctor who is ordering the procedure to provide you with the procedure code and the diagnosis code for the test.

Call your insurance company, tell them what you are having done (give them all the codes provided) and ask them to tell you what the cost will be if you have the test at the hospital, urgent care, or if you have it at an independent radiology practice (you will have to give them the name of specific locations in order for them to respond). They will confirm the contracted rates at each facility and they will be able to confirm, based on your plan and its deductibles, how much of that fee you will be responsible to pay. You can then factor this financial piece into your decision about where to have the procedure done.


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