Health Insurance and billing?

Question

i have a question for my friend.

my friend is a full employ staff and her insurance plan under the work place is health net. my friend recently has a yearly physical checkup and usually, her company insurance is responsible for paying everything. but she has been receiving partial bills from the insurance for many of the exams like mamogram, bloodtest (ie) where she need to pay the remaining about which they claim the insurance is limited to pay a certain amt (for exmaple: $325, health net is responsible for 300, my friend is bill for $25).

my question is shouldn't the insurance be paying for everything

since i dont know much about insurance, can someone please help.

Answer 1

sounds like shes got a ppo.

shes either paying

a copayment (flat dollar amount)

co insurance (percentage)

deductible (amount that applies to certain services before the insurance will pay for anything)

you should tell her to call the insurance and get a benefit book or log on line and check the benefits.. sounds like she isnt familiar with her plan.

Answer 2

Perhaps You may google it first ,however, if you like some direct resource ,here might be your choosing.http://health-insurance.expert-tip.info/...

Answer 3

No, the insurance doesn't pay for EVERYTHING.  She should have copayments - her portion of every claim.

Answer 4

Most health plans do NOT pay everything.  They pay a portion but the employee has to pay deductibles and co-pays.  She needs to read her plan coverage provisions.

Answer 5

Unfortunately, no one here can answer your question. Your friend needs to get her coverage info from her employer and make sure the insurance is paying according to that. It's possible that the coverage changed and she is now responsible for a co-pay for certain services.