I received a billing statement. How do I know my insurance company paid its portion?
If you have questions about insurance payments, please call your insurance company directly. The insurance company’s phone number is usually printed on the back of your insurance card.
Why is a portion of my bill covered by my insurance, while the rest is not covered?
Coverage can change every year depending on your benefit plan. This determines whether or not a patient’s bill is covered by insurance. Hospital coverage often has patient responsibility including deductible, copayment or coinsurance. Since each plan can be different, we encourage families to carefully review their benefits with their insurance company.
Should I inform my insurance company that my child is going to be in the hospital?
Most insurance companies require you to notify them before you have an inpatient or outpatient visit. Some visits will also require a referral from your primary care physician. We encourage you to check with your insurance company to find out the specific requirements for your insurance plan prior to your visit.
Do I need to have my insurance card or my child’s insurance card with me at the hospital or clinic?
Yes, it is very important that you bring your updated insurance card with you to ensure that we get the insurance billing information to accurately file your claim. You will be asked to present your card each time you register.
How do I know if Children’s Colorado accepts my insurance?
We accept many insurance plans. Please check with your physician to ensure that he or she is an in-network provider. You may have to pay additional costs for out-of-network services.
How do I know if my child’s visit will be covered by my insurance company?
Health benefit coverage varies with each insurance company or employer group. Please refer to your insurance member handbook or call your insurance company with questions regarding coverage for specific services.
What should I do if I think that my insurance company has paid my bill incorrectly?
If you disagree with the insurance company’s payment amount, contact the insurance company directly and ask them to review how the claim was processed. If the insurance company determines the bill was paid correctly and you still disagree, please contact your benefit manager with your insurance company. They can provide guidance on how to file an "appeal" with them. Filing an appeal will ensure that your claim will be reviewed for reconsideration.
How do health insurance co-pays work?
A co-pay is a monetary charge that your health insurance plan may require you to the pay in order to receive a specific medical service or supply. Co-pays vary by policy and can change depending on the type of visit.
Example: Let's say Gary goes to a Children’s Colorado specialist with a case of mono. His specialist reviews his insurance and sees that he has a $25 co-pay based on his insurance benefits. His co-pay is collected, and his insurance company will reimburse the specialist for the difference between the co-pay and the cost of treatment.
Here's another example: Say your plan’s deductible is $2,500, your plan covers 70% of services and your out-of-pocket max is $7,350. Setting aside copays, here’s what your year looks like:
How do health insurance co-insurances work?
Co-insurance is the way you and your health insurer share the costs of your care. For example, if Gary is injured and he’s met his deductible for the year, his health plan will pay 80% of the cost of his bills, leaving him responsible for the remaining 20%.
How do health insurance deductibles work?
Your deductible is the amount of your medical costs that you have to pay before your health insurance will pay benefits consistent with the benefit plan.
Example: Gary has a health plan with a $1,500 deductible. If Gary only has minor health expenses during the year that cost less than $1,500 total, he's going to pay the full amount to treat them. However, if Gary has a serious illness that requires a lot of medical care, he'll pay his $1,500 deductible and then his health insurance will pay benefits consistent with the benefit plan.
Summary of health insurance deductibles, co-pays and co-insurance
- You pay co-pays when you see the doctor.
- Co-insurance is how you and your insurance company split up the cost of your care.
- Deductibles are the portion you must pay before your insurance pays.