Insurance Basics: Home
After you get care, your provider sends a bill, or “claim,” to your insurance company. Your insurance company handles the claim and sends you an Explanation of Benefits (EOB).
Since providers are able to decide how much to charge for out-of-network care, sometimes that charge might be higher than you expected.
Most health plans don´t cover treatments they regard as “experimental”. Sometimes, they may deny a claim for such a treatment.
If you´ve been diagnosed with a chronic condition, this article will give you some guidelines to help manage your care and costs. In it you will learn how you can get help to:
Suppose you receive care in a hospital that is in your health plan´s provider network. You may still get a bill from providers who treated you at the hospital but are not part of your plan´s network.
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."