Insurance Basics: Home

Planning Your Costs Based on Where You Get Care

Your plan may have different rules and costs for different healthcare settings. In any setting, you may have to pay a copay, and in some cases, coinsurance. But, these may be waived for preventive services like flu shots and mammograms.

Planning Your Costs Based on Where You Get Care
In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Code Modifiers: How they Affect You

Doctors and insurers use standard codes for each medical service or supply. That helps them communicate about treatments and payments clearly.

Provider Networks

Your plan may contract with doctors, dentists and other healthcare practitioners; hospitals; labs; radiology facilities; pharmacies and other types of providers. These are the providers in your “network”.

Having More Than One Health Plan

Being covered under two health plans doesn't mean the two plans will pay the same amount twice for the same doctor visit. Instead, the plans follow rules about which plan pays what, known as "coordination of benefits."

Getting Covered for Alternative Medicine

Acupuncture, chiropractic care and massage therapy have one thing in common: They may not be covered by insurance. That’s because they may be looked at as alternative treatments, not part of conventional medical care.

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