Insurance & Billing
While you are a patient of the Corpus Christi Medical Center, your full attention should be on your treatment, and not on worrying about your insurance coverage. We accept most major insurance carriers and will work with them to make sure that you receive your full insurance benefits. Don’t get overwhelmed by paperwork - call our office for assistance if you have questions about your bills and coverage. The following is a list of insurance terms and what they mean in terms of what you might have to pay versus what the insurance company pays for you:
Annual Coinsurance Limit (Maximum Out-of-Pocket)
The amount of money you must pay out of pocket before your insurance pays for 100% of your bills. Your total out-of-pocket expenses include your deductible and the percentage of hospital and other costs (usually 20%) that your insurance requires you to pay. For many insurance companies, the annual coinsurance limit is between $2,500 and $5,000 per person, per year.
Choice of Medical Service Provider
Does your insurance allow you to choose your own doctor, or do they have a list of doctors that you must use? Many times, if your doctor is not on the insurance company’s list, you must pay higher deductibles or copayments in order to see that doctor.
Copayment
This is a fixed amount that you pay to see your doctor for each visit. This is more common with HMO or PPO types of insurance.
Health Maintenance Organization or HMO
HMO is a type of insurance that contracts with groups of doctors and facilities to provide managed care to its patients. HMOs usually have restrictions on the doctors/facilities you may use, and most require a referral from your primary care doctor to see a specialist.
Home Care Visits
Home care visits are sometimes necessary with cancer care. Does your insurance cover home care visits, and if so, how many visits per illness or per year?
Hospital costs covered
Most insurance carriers cover the majority of your hospital costs, but not all of them. Your hospital co-insurance might be between 10-30%; some providers may pay 100% of hospital costs if you use their preferred hospital.
Lifetime maximum
The total amount an insurer will pay for your medical care for as long as you are on their policy. The lifetime maximum on policies may range from $1 million to unlimited coverage (i.e. as long as you are covered, they will pay for your medical expenses)
Medicare Part A
Government managed hospital coverage for people over age 65 who have paid into the Medicare program as part of their Social Security. This coverage does not have a premium.
Medicare Part B
Government managed medical (doctor’s visits, etc.) coverage for people over age 65. This part of Medicare is not free, you must pay premiums to have Medicare Part B.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is a private HMO or PPO combination plan for Medicare Parts A and B. Many also include prescription coverage as well. The participant pays a premium for the medical and prescription coverage.
Medicare Part D
Government managed prescription drug coverage.
Preferred Provider Organization or PPO
PPO a type of insurance that contracts with a number of doctors and facilities to provide care. While similar to HMO insurance, most PPOs have more flexibility for patients when choosing doctors, etc, although PPOs usually have lower copayments or deductibles for using doctors/facilities on their approved list.
Prescription Drugs
What does your plan pay for prescriptions and is it subject to a deductible? Many plans offer a significant discount for routine prescriptions if they are filled through the plan’s approved mail order pharmacy. If your plan offers this discount, be sure to let your doctor know so that he/she can write the prescription to comply with their plan.
Prior-Authorization
Most insurance plans will want to review a doctor’s plan of action for medical procedures to ensure that they are medically necessary. This is something that your doctor’s office will do for you – you do not have to make the contacts.
Second Opinions
Does your plan pay if you consult another doctor about your treatment plan?
Yearly Deductible
This is how much money you must pay out of pocket for your medical bills before your insurance starts to pay. Different insurers sometimes will exempt different procedures from deductibles – for example, preventative care and tests may be paid at 100% without the deductible.
If you do not have insurance or are having financial difficulties
Many cancer patients who are not covered by insurance may be eligible for other assistance programs. Listed below several programs – some will be able to help pay for your care, while others will be able to assist you with other items such as food, medical supplies, etc. If you are having financial difficulties due to your diagnosis, whether you have insurance or not, you need to let us know so that we can help you find programs that can help you.
American Cancer Society – 1-800-ACS-2345 – provides local transportation to treatment, durable medical equipment such as hospital beds, wheelchairs and walkers; patient services specialists can assist patients with financial and insurance questions.
Leukemia and Lymphoma Society - (800) 955-4572 may be able to assist with co-pays, prescription drugs, transportation expenses and other financial needs for patients who have leukemia, lymphoma or Myeloma cancers.
Partnership for Prescription Assistance – 1-888-4PPA-NOW is a clearinghouse for most of the prescription drug assistance programs in the country. By applying for assistance through them, the patient should have to apply for assistance only once instead of for each program individually.
Patient Advocate Foundation – 1-800-532-5274 can assist with insurance questions/problems and may also be able to help with copayments
Social Security – 361-806-5560 may assist with qualifying you for either SSI (based on financial need) or SSDI (if you have paid into social security and have enough quarters to qualify) disability payments if you are permanently disabled.
Texas Medicaid– 361-855-9924. You may qualify financially for state insurance assistance.
Veterans Benefits – 361-854-4349. If you are a veteran, you may qualify for veterans’ health benefits