I’ve got some advice for people that have health insurance coverage and are looking to change doctors or providers. When you call the receptionist or visit the office, you must ask them if the office and the doctor are “CONTRACTED” with your insurance company. Everybody “takes” the insurance, but if they are not contracted, they are not bound by the fee structure that your insurance company has set up. The doctor can basically charge whatever they want for their services, the insurance company will pay the “contracted” rate, and YOU are responsible for the difference. Its called BALANCED BILLING. People that have really good Employee Health Benefits end up getting the short end of the deal because they don’t use the right “words” when they inquire about the coverage.
California Employee Health Insurance should not be like that. This is already a very dysfunctional system, as you can imagine, and this is one of the things that people WITHOUT a qualified insurance agent will run in to. This becomes a problem when a company has Group Employee Benefits with an insurance agent that does NOT specialize in Benefits. It’s like going to a General Practitioner for a very specific and focused issue….for doctors and insurance agents, there is just not enough hours in the day to become an expert in ALL areas. Do yourself a favor and spend some time researching a good INDEPENDENT Employee Benefits Broker to handle your needs!
Steve Brauer