Now that you have found a provider and had your first visit, where do you go from here?
You’ll see your primary care provider for your recommended preventive care and for help managing chronic conditions, as well as when you feel sick. Even if you see a specialist for a specific service or condition, you’ll always come back to your primary care provider.
Ask your provider or their staff to notify you when your next visit or recommended health screenings should happen. Make an appointment for that visit as soon as you can and write it down someplace where you’ll remember it, or in the back of this book.
If you have questions or concerns between visits, call your provider. They can help answer questions you have about your health and well-being and adjust any medications you are taking.
Pay your bills and keep any paperwork. Some providers will not see you if you have unpaid medical bills. You may be able to go online to look up your own health information, such as screening and test results or prescribed medications. This can help you take charge of managing your health.
Appeals and grievances
If you have a complaint or are dissatisfied with a denial of coverage for claims under your health plan, you may be able to appeal or file a grievance. For questions about your rights, or assistance, you can contact your insurance plan or state program. If you think you were charged for tests or services your coverage is supposed to pay for, keep the bill and call the phone number on your insurance card or plan documentation right away. Insurance companies have call and support centers to help plan members.
Explanation of Benefits Terms
1. Service Description
A description of the health care services you received, like a medical visit, lab tests, or screenings.
2. Provider Charge
The amount your provider bills for your visit.
3. Allowed Charge
The amount your provider will be reimbursed; this may not be the same as the Provider Charges.
4. Paid by Insurer
The amount your insurance plan will pay to your provider.
5. Payee
The person who will receive any reimbursement for over-paying the claim.
6. What You Owe
The amount the patient or insurance plan member owes after your insurer has paid everything else. You may have already paid a portion of this amount, and payments made directly to your provider may not be subtracted from this amount.
7. Remark Code
A note from the insurance plan that explains more about the costs, charges, and paid amounts for your visit.
Contact your health plan if you have questions about your EOB.
