How do I know if my medical bills will be covered? (gynecologist, health insurance)

[my_opinion]

I have this Kaiser Permanente insurance. I am going to schedule an appointment with a gynecologist. My question is: how do I know all the examinations and lab tests will be covered by my insurance. Shall I ask doctor to give me a checking list, then call Kaiser Permanente to make sure if every item will be covered? How does everybody do about such thing? I just don't like the surprises when I receive the bill from hospital that some are not covered which I might have known before taking the examination.

Is there anybody knowing more about this? Thanks in advance.

[jjpop]

I think with Kaiser, since the doctors and clinics are employed by the insurance company, you should be able to settle this when you check in for your appointment.

Someone with KP could correct me, but I'd imagine that there will be a copayment and that should cover all of the treatment delivered during that appointment. The insurance will pick up the rest.

[hamellr]

I usually call the doctor and say hey, here's my insurance carrier and number. What is my total out of pocket going to be?

[jjpop]

Actually, it's not clear in your original post if your appointment is with a Kaiser Permanente doctor, or someone outside of their network. What I said up above, I believe, applies if the gynecologist is within their network (employed by a KP clinic or hospital). If you go outside of the network, KP may not cover any of the cost unless you received pre-approval.

Again, somebody who has Kaiser insurance should chime in here and give us the straight poop.

[Rob Allen]

I have Kaiser coverage, and jjpop is basically correct. I don't think of it as "insurance", really. It's a health service, and members have access to their doctors, labs and other services.

If your appointment is at a Kaiser facility, you check in when you arrive and pay whatever co-pay your plan has. Everything is included except prescriptions which have their own co-pay. That's how my plan works, anyway - yours might be different. Call Kaiser's Member Services department and check on your coverage.

If your appointment is with a non-Kaiser doctor, you pay for it. Kaiser doesn't want to know about it. The only thing they cover outside their own facilities is emergency hospitalization.

[Minervah]

A Kaiser doctor won't order tests that are not covered by a Kaiser facility. This is an HMO so it works differently from choosing a service or doctor and determining whether or not the services will be covered by an insurance policy.

Kaiser will pay only for services that are approved for which they have no facilities. Case in point: a few years ago my friend who was a Kaiser member had a rare Cancer. Kaiser actually sent her to a specialist at Providence Hospital who was an expert on her type of Cancer. It didn't cost her a cent. Kaiser has since added this type of specialist to its staff so this would not hold true today.

Let me give you the best advice possible. I was a health insurance claims examiner for over 30 years. The biggest mistake my clients made was to ask others if something was or was not covered. You must go to the source and ask your client services through your HR department or directly to the insurace customer service department.

Insurance coverage is like snow flakes. No two policies and situations that fall under the policies are necessarily alike.

[my_opinion]

Wow, thanks for everybody!!! I scheduled an appointment with Kaiser facility, and the lady who arranged this for me already told me how they will let me know my coverage before taking any further tests. So I think I will be fine without any unexpected surprise.

I learned a lot from your replies, thank you all very much!!!