Understanding Your Insurance

Understanding Your Insurance 30November

Written by: Mitch Bruce, Patient Account Manager, Wickenburg Community Hospital

Insurance is CONFUSING!  Medical insurance is no exception.  To make things worse agents start tossing around terms like in network, HMO, and pre-auth, it’s no wonder we have difficulty understanding what we’re really paying for.

Here at Wickenburg Community Hospital we are asked a lot of questions about health insurance and how it works.  By understanding some of the key terms, you will find navigating through your plan a little easier.

PCP = Primary Care Provider, some plans require that you choose a PCP.  If you have a PCP listed on your insurance card this is the provider you must see for your regular care.

PPO = Preferred Provider Organization, these are providers that are part of your insurances network so claims will be processed as “in network” for maximum benefits.

HMO = Health Maintenance Organization, this is a network of providers to include specialists that are part of your insurances network that is usually local and very small.  This requires that you choose a PCP and all care must be routed through that provider. It also requires referrals to Specialists.

IN NETWORK PROVIDER = this is a provider that is contracted with your insurance to see patient within a specific network.  This usually means less out of pocket cost for patients.

OUT OF NETWORK PROVIDERS = this means that this provider is not contracted with your specific network even though they may take your insurance.  This usually means a higher out of pocket cost for the patient.

OUT OF POCKET = the amount the patient has to pay for a service.  This is determined by the insurance company.

Hopefully, these explanations help to clear up some insurance confusion.  If you have a specific question please give our business office a call as we are happy to help! 928-684-4365

 

Primary Care

Community Hospital Clinics are located in Wickenburg, Wittmann, and Congress. We sincerely follow our mission to provide quality health and wellness services where the patient, family, and community come first.

Read More

Emergency Care

Our 8 bed Emergency Room department is fully staffed with emergency physicians, nurses, and ER specialists. Your wait time is typically measured in minutes not hours as in the larger metropolitan hospitals.

Read More

Surgical Services

Wickenburg Community Hospital provides a wide variety of surgical care and treatment. We serve a vibrant and active community who favors quality health care close to home.

Read More