Insurance participation, coverage and patient charges can differ by clinician, location and service. A past statement that a clinic accepted a plan does not establish coverage for a new visit. Confirm details with both the office and your health plan.
Before an Appointment
- Ask whether the treating provider participates in your specific plan.
- Confirm whether your visit needs a referral or prior authorization.
- Check the copayment, deductible and any coinsurance that may apply.
- Ask how laboratory, imaging or outside specialist charges are billed.
- Request an estimate if you are paying directly or a service is not covered.
Common Billing Terms
Deductible: the amount you may need to pay for covered care before your plan begins sharing certain costs.
Copayment: a fixed amount due for a covered service under your plan.
Coinsurance: your percentage share of covered costs, subject to the terms of your coverage.
If Paying for Care Is Difficult
Tell the clinic before the visit if cost may prevent you from receiving care. Ask whether an income-based fee arrangement, payment plan or assistance program applies, what documentation is needed and which services are included.
Do not use the fee amounts from old schedules as a current quotation. Ask for the current policy and a written explanation of any estimate.
Questions About a Bill
Have the invoice, date of service and insurance explanation of benefits available. Ask what was billed, what the insurer paid and why a balance remains.
Payment information and contact details are available for the next step.