What Your PCP Can Tell You About Insurance

What Questions You Should Be Asking

What Your PCP Can Tell You About Insurance

Many people have the same doctor they’ve had for many years. Some in rural parts of the country have very little options and may use the only doctor in the area. Whether you’re switching from state or private insurance to group insurance or Medicare, you should be able to ask your primary care physician (PCP) questions, and they should be able to answer.

Questions to Ask During Your Appointment

You can save yourself a headache and a bill by asking questions during a routine appointment. You might ask for bloodwork, but the panel that your doctor orders isn’t covered completely, leaving you with a debt you aren’t ready for. Many patients simply go with whatever the doctor orders, assuming the doctor knows your insurance coverage. This is wrong! Many times the physician doesn’t know your insurance status at all. That’s not what you pay them for.

During your appointment, don’t forget to ask your doctor:

What if my medication isn’t covered by my insurance prescription plan?

This question shouldn’t bother your PCP in the least. Ask if the prescription can be changed to a generic alternative if it isn’t covered and what the process is like. Can you simply call the clinic and request a change? Does your PCP know of any discounts on those meds?

Where will my labs/X-rays/procedures take place?

Your doctor may not realize that your coverage may change depending on the location of the treatment. If the clinic outsources labs to another facility, your insurance may not cover one place, but will cover another. It is important to understand your own coverage, and make sure that you have all the facts before you leave the doctor’s office.

How long will this take?

If you are looking at a procedure that is covered by your insurance, you need to make sure the hospital stay will be covered. Hospitals have to charge for everything during your stay, and your insurance coverage may leave a gap for you to fill--resulting in a medical debt you aren’t expecting. Make sure that you know how long you will need coverage, and how much your insurance will cover.

Can I get that in writing?

If you are anticipating a high cost or a difficult experience with your insurance provider, ask your PCP for your medical record following your visit. If the doctor has mentioned a diagnosis during your visit, make sure that it is documented so that your insurance will cover treatment. If your PCP mentions a possible diagnosis, ask how you can rule it out in order to avoid costly insurance premiums in the future.

What type of coverage do you recommend?

If you are shopping for health insurance, your primary care physician will have a recommendation. Asking your PCP is helpful during the process because he or she knows you and your medical history well and can make a recommendation based upon your case.

 

What Your PCP Can Tell You About Insurance

Meet the Author:

Rachel Ashworth


Rachel Ashworth is originally from the Midwest, her expertise is writing research-based articles about health and wellness. Specific interests include mental health and addiction. Rachel has written on a wide range of topics including parenting, fitness, health, fire safety, home maintenance, medical insurance, and dental care. She spends her time writing, volunteering with her church and community, and teaching her children.


Rachel Ashworth is originally from the Midwest, her expertise is writing research-based articles about health and wellness. Specific interests include mental health and addiction. Rachel has written on a wide range of topics including parenting, fitness, health, fire safety, home maintenance, medical insurance, and dental care. She spends her time writing, volunteering with her church and community, and teaching her children.