The UNMC Human Resources office will be sharing a series of articles designed to help employees better understand their benefits. This week’s UNMC Benefits Corner details how much an employee’s health insurance will pay for medical treatment and prescriptions.
The doctor bills cometh! How much will my health insurance pay?
You’ve been miserable for a few days and finally go the doctor. He orders some tests, identifies the medical problem and recommends a course of treatment, possibly including a prescription drug. Do you know how these charges will be handled?
First of all, if you are given a prescription it is not covered under your Blue Cross Blue Shield insurance. All participants in UNMC’s medical insurance plan have their prescription coverage through Caremark. You should have a separate card for prescriptions (if not, call your benefits office at 559-4340 or 559-5911). Present your Caremark card at a participating pharmacy, pay your co-pay and receive your medication.
For your medical treatment, if you have gone to a preferred provider they will bill Blue Cross Blue Shield for the charges. If you have utilized a non-preferred provider you may be required to pay at the time of the office visit and send the claim to the insurance company yourself.
When Blue Cross Blue Shield receives the bill, they will first apply those charges to your deductible. The deductible is the amount of money you must pay out of pocket each calendar year before Blue Cross Blue Shield will start making payment on claims. Once your deductible is met, Blue Cross Blue Shield will begin paying a percentage of the charges, and you will pay the remainder (this is called the co-insurance).
If you incur a large medical bill, perhaps through a hospitalization or very expensive tests, you may reach your stop loss limit. This is the total amount of co-insurance a covered person must pay in a calendar year (in addition to the deductible). Once the stop loss limit has been reached Blue Cross Blue Shield will pay 100 percent of the usual and customary charges for the remainder of the year. Each time Blue Cross Blue Shield processes a claim, you will be sent an Explanation Of Benefits (EOB) so you know exactly what (if any) went to the deductible, what amount is paid to the provider and what is your responsibility.
Send any questions to Benefits@unmc.edu.
Look for your NU Flex 2003 information in mid-November.