I have recently moved in the United States, and I have a health insurance through my local employer. How to be sure a medical appointment will be fully covered by my health insurance in the United States? (or at least that I will only have to pay a fixed copayment.)
Here are the options I have considered:
- if I call the health insurance's customer service prior to my appointment, neither I nor the customer service can guess in advance the diagnosis and procedure codes the physician will bill me for.
- if I call the physician prior to my appointment, they cannot guess in advance diagnosis and procedure codes they will bill me, because it depends on what will happen during the appointment.
- the health insurance refuses to provide a listing of procedure and diagnosis codes that are covered upon request.
- asking the physician whether the appointment is covered is pointless as nothing legally bound the physician to be correct regarding insurance coverage, and he may simply say he does not know.
None of these options work. What shall I do? Bills can be pretty expensive in this country, even a simple medical appointment may be bill for ~500 USD.
Answering mkennedy's comment: I can check (and I do check) whether the physician is in-network prior to the appointment. But even an in-network physician may result in an uncovered appointment (first-hand experience). Co-workers do share some information, but of course nothing legally binding and information is partial, so it's really not enough. Also it's not so great for patients' privacy. HRs refer me to the insurance's customer service