Now, more than ever, it has become incredibly difficult to determine what procedures, medications, and treatments insurance plans cover. As healthcare continues to evolve and new services develop, the lines between "covered vs. not covered" will become increasingly blurred, making it difficult for patients to make accurate and fiscally responsible decisions. Today, we're going to outline a couple of tips to estimate your patient responsibility for a knee injection near you.
Before you read this article, if you have not checked out our blog on types of knee injections, please scroll down and review that information. Choosing the right knee injection for you, should be a clinical decision first(what's best for my health?), THEN a financial decision (what's this going to cost me?) second. If you have questions about what injection type is best for you, always consult a licensed medical professional near you.
The first step to seeing what a knee injection is going to cost you, is carefully reviewing your Explanation of Benefits (EOB). If you do not see the particular procedure listed on your EOB, then you have the right to call your insurance company and ask them to look the procedure up. In return, insurance companies have to tell you YOUR responsibility before you have the procedure done. This out of pocket amount is dependent on a couple of factors such as:
-Does your deductible apply to the service being provided?
- Has the Deductible been met prior to the service being provided?
-Is there a medical office copay for the type of office visit/provider you're seeing?
-Is there coinsurance for the procedure type you're receiving? (this is a percentage of the amount the insurance agrees to pay the provider. For example, 0if there is a $1000 procedure with 20% coinsurance, the insurance would pay providers $800 while the patient pays $200
-Is the procedure medically necessary based on your diagnosis from the medical provider?
-Are there other treatment options you have to try BEFORE receiving the knee injection?
The second step to determine your out of pocket costs for knee injections would be, to ask the medical provider to preauthorize your insurance. This is a little bit different than calling your insurance company for one main reason: establishing medical necessity. When you receive your exam, the provider diagnoses you with a code called an ICD-10 code. Essentially, this is a code that establishes the severity of your condition, how long it's been going on for etc. Certain procedures require certain diagnosis codes. Therefore, certain knee injections require a certain diagnosis before getting approved. By asking your medical provider to pre-authorize your insurance , you are asking them to use the diagnosis codes to communicate with your insurance about what they will cover; and what your out of pocket cost will be.
When trying to figure out what type of knee injection is best for you, asking a licensed medial professional which type will benefit your health the most is always the best thing to do. However, we also live in a world where medical services can be expensive if they are not covered. By using the tips outlined above, you will have a much clearer picture of what your expenses will be, BEFORE you get the procedure.
Stay tuned to the Modern Concepts blog for more tips!