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When you go to a health care provider, your health insurance identification ID card shows the provider which plan you have and the payment you are expected to make for the service.
The provider then sends a claim a bill for the services provided to your insurance company, and, if the service is covered, the insurance company pays the provider for the service.
You will receive an Explanation of Benefits EOB statement from the insurance company that tells you the amount the insurance company paid for the service and any remaining amount that you owe the provider.
If you did not pay at the time you received care, you will receive a bill from the provider for the amount you owe. In addition to your premium , the amount you pay each month for your health insurance, you may have to share the costs of the services you receive. For example, if the health insurance company pays 80 percent of the cost for a service, you would pay 20 percent coinsurance. The health insurance company pays the remaining cost. Can be before or after deductible.
A Preferred-Provider Organization PPO gives you access to a network of participating doctors, hospitals and other health care providers. If you receive care from a network provider, you pay a lower share of the cost.
You can also choose to go to a doctor or hospital out of the network and pay a higher share of the cost for your care. You do not need to have a primary care physician to coordinate your care. Your HSA can be used to fund your out-of-pocket medical expenses using tax-free dollars.
A provider is any doctor, specialist, hospital or rehabilitation facility, for example, where you get health care. They also file claims for you. Out-of-network providers do not have an agreement with a health plan. When selecting a health care coverage plan, you will want to research specific details about the plans you are considering, including:.
Covered services — Most plans cover doctor visits, hospital stays, surgery and emergency care. But if you want coverage for prescription drugs, vision or behavioral health, make sure the plan offers it. Deductible — How much of your health care expenses are you responsible for paying before the plan begins to cover your care?
If you are covering family members too, do you need to meet more than one deductible? Or do expenses for all covered family members count toward a single deductible?
Cost-sharing — What portion of the cost for services is paid by the plan and how much will you be responsible for? Are those costs within your budget? If you use providers outside of the network, how much more will you pay for care?
Preventive care — This usually includes yearly check-ups, mammograms, Pap tests, prostate exams, immunizations and well-child visits. What kind of preventive care is covered? Are there limitations on that care, such as the number of visits per year? Maximums — Are there limits on how much the plan will pay for your care? Health Savings Account — To enjoy the tax advantages of a Health Savings Account, should you consider enrolling in a qualified high-deductible health plan?
There are lots of things you can do to improve your health, become an educated health care consumer and help control health care costs. With more providers than competitive plans, chances are good that your current physician and hospital are part of our extensive provider network.
Find a Doctor, Hospital or Medical Provider to see if your provider is in our network. Your PPO Plan has you covered no matter where you are. As a Highmark member, you enjoy all the services of BlueCard Worldwide. Your coverage travels with you through a worldwide network of care providers. For more details, please ask your local Highmark Direct health insurance store associate. To help make health insurance more affordable, the government offers two types of financial help to eligible households - depending on your household income and other factors.
If you qualify, a Premium Tax Credit may be applied in advance to lower what you pay in monthly premiums on any Health Insurance Marketplace plan.
The amount of a Premium Tax Credit is based mostly on family size and income. Cost-Sharing Reductions CSR will lower your out-of-pocket costs that you may pay at the time of service for doctor's visits, lab tests, drugs and other covered services. You can only get these savings if you enroll in a Marketplace Silver Metal Level plan.
Visit your local Highmark Direct store or Healthcare. If your plan does not have set copays, services will be subject to your in-network deductible. This does not include any services not covered by your plan. Your premium depends on the plan you select. Your premium is the amount you pay each month for your health insurance. A Highmark Direct health insurance store licensed associate will be able to walk you through plan options to help you understand your benefits and find a plan that fits your needs.
Your deductible or coinsurance depends on the plan you select. Your copay, if any, depends on the plan you select and if you are seeing your primary care physician or a specialist.
Prescription drug coverage varies based upon your health insurance plan. If you are current Highmark member and have questions regarding your medication costs, please contact customer service reference the back of your ID card for contact details or if you are shopping for insurance, speak to an associate at your local Highmark Direct health insurance store for more information.
Once you have this information, you can contact member service for the medical procedure cost. We offer a standalone dental policy through United Concordia.
At this time, we do not offer a standalone vision plan, however vision is included in most of our policies. If you have specific questions, please contact your local Highmark Direct health insurance store. Please note: Short Term coverage does not cover pre-existing conditions.
There are many services that are eligible as part of your preventive benefits package. Eligibility of services will be based on age, gender, and when the last service date was. It is best to contact member service at the time of your visit with a list of services that your health care provider will be performing or check the Preventive Schedule on our website. Under the Affordable Care Act ACA , health insurance plans must provide coverage for adult dependents under age 26 on their parents' policies.
Your number of visits depends on your selected plan. Gym memberships are not a covered benefit under the terms of your health insurance policy.
However, you may be entitled to receive a discount through our member wellness discount program. Would you like to view these online or schedule an appointment?
Enter your starting address. Enter your zip code to continue. Please select your county to continue. You have selected the store. Would you like to schedule an appointment at this location? For accommodations of persons with special needs at meetings call and TTY may call There is no obligation to enroll. Call your local Highmark Direct Retail Store or click the link above to schedule an appointment. What can I do at a Highmark Direct health insurance store?
Current and potential Highmark plan members meet one-on-one with a store associate to: Learn about plan options Compare and shop for plans Enroll in a plan Make payments Receive help with health care tasks, such as scheduling appointments, finding a provider and transferring medical records Resolve medical billing issues Engage in other store services You also can attend free programs and seminars on healthy living and Medicare.
Our plan options include: Highmark Medicare Advantage plans , including private health insurance Part C , standalone prescription drug coverage Part D and Medigap supplemental insurance Individual and family plans Other insurance, such as travel and dental insurance How much time should I expect to spend at my appointment? What is a Highmark Direct health insurance store? We offer many convenient options in-store to help answer your customer service questions: In-Person Customer Advocates -- We now offer in-store customer service at all of our Highmark Direct health insurance store locations.
Consumer Affairs gives Highmark 2. Some costs that are considered include monthly premiums, copays, and coinsurance, maximum out-of-pocket limits, and annual deductibles.
Tammy Burns is an experienced health insurance advisor. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service. Updated: May 22, Reviewed by: Tammy Burns. How Is Highmark Rated? Is Highmark Good Health Insurance? What we like about Highmark health insurance plans: The drawbacks of Highmark health insurance plans: You can see specialists without obtaining referrals Some plans provide dental and vision coverage Free preventive care visits Coverage is only available in four states Only exclusive provider organization EPO options are available No coverage for seeing out-of-network providers.
Highmark Health Insurance Plan Options. Overall rating: 4. Financial strength: 4. Tammy Burns.
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Highmark Health reports $22 billion in revenue and $ million in earnings through year-end Highmark Health is launching Well Diabetes Management, a virtual care program . Highmark operates within the Highmark Health enterprise, a diversified health and wellness system in Pittsburgh. Between Highmark and other affiliates beneath the Highmark Health . Dec 28, · About Highmark This profile has not been claimed by the company. See reviews below to learn more or submit your own review. Overall Satisfaction Rating 5 stars 4 stars 3 .