NCQA maintains an up-to-date list of insurers in Wisconsin.
Contact your insurer.
Explain what is to be done, when it will be done, and by whom (hospital/physician).
Confirm the provider will be covered, and if the provider is in-network or out-of-network (this will affect coverage).
Confirm that the procedure will be covered.
Ask if there are any other limitations to the coverage.
Ask what the expected out-of-pocket costs will be.
Ask if the out-of-pocket costs would be less if a different hospital/physician was involved.
The PricePoint web site provides information on billed charges for all types of inpatient and selected outpatient services. However, lower hospital charges may not
necessarily mean that you will pay less out of your pocket. That is why it is important for you to contact your insurer BEFORE the procedure.
Many commercial insurance companies or employer self-funded plans require enrollees to seek care exclusively from a specific group of hospitals and physicians under contract
with the insurer or employer in order for the the service to be covered. The group of hospitals and physicians is often called a "network".
Other insurers and employers will cover the services of hospitals/physicians that are NOT in the network, but require the patient to pay a higher percentage of the cost for
using those hospitals/physicians.
If you are required to use the services of physicians who are in your insurer's network to receive the highest level of coverage, ask your insurer to provide the names of the
anesthesiologists, pathologists and radiologists in the network who provide services at the hospital. These are types of physicians who may provide services related to your
inpatient stay or other hospital service, but it's possible you may never interact personally with them. As with surgeons, they are often not employees of a hospital and therefore
their services will probably be billed separately. If they are not part of the insurer's network, you may be responsible for a larger portion of their fee, or the entire fee.
Information on some professional fees can be found in PricePoint's Professional Services report.