Insurance basics for Cougs

About 66 percent of Cougs are still on their parents’ health insurance plan! Whether you use your parents’ insurance or have your own plan, our healthcare system is complex and learning to navigate it on your own can be tough. Here are some insurance basics to keep in mind next time you make a medical appointment.

Check to see if your healthcare provider is in-network

Insurance companies have contract agreements with certain healthcare providers, who are considered in-network. Insurance plans generally provide more coverage for services performed by in-network providers, which lowers the amount you have to pay out of pocket.

You can usually find a list of in-network providers in your area on your insurance company’s website. Or, you can check your healthcare provider’s website or call them to get details on what your insurance will cover.

For Health & Wellness Services, check our list of contracted insurance companies or contact our billing office for details. If you have WSU insurance as an international student or graduate assistant, you can find more info on our student insurance website.

Find out if you need a referral

If you need to see a specialist or get a specific medical service, you may need a referral. If you’re visiting a healthcare provider other than your primary doctor’s office, check with your insurance company to find out whether or not you need a referral.

If you need a referral and don’t get one in advance, you may have trouble getting your insurance company to cover the service. If you need to see a specialist for any reason, our medical clinic can help you with referrals to local providers.

Know your annual premium, deductible and copay

An annual premium is the amount you or your parents pay to have your health insurance plan. In any given year, you have to pay a set amount of medical expenses out of pocket before your insurance company will pay for any services. This is called a deductible.

At each medical appointment, you may also have a copay or co-insurance. After you’ve met your deductible for the year, all you have to pay is your copay (a set amount of money) or co-insurance (a set percentage of total cost) and your insurance company will cover the rest of your bill.

If you aren’t sure how much your visit will cost, your healthcare provider’s billing office can help you figure out your coverage and how much you’ll owe.

Check your Explanation of Benefits (EOB)

After your insurance company pays for a medical service you’ve received, they’ll send you a document called an EOB. Your EOB will tell you what the claim was for, whether it was approved and for how much.

Depending on your insurance company and the preferences you’ve set, you may receive your EOB in the mail or electronically. When it arrives, make sure the information is correct and contact your insurance company if you have questions.

Explore your options

If you don’t have health insurance, low-cost insurance options are available through the Washington State Health Benefit Exchange. Open enrollment for 2017 plans is happening now!

If you need help navigating your insurance options or have any concerns about how to pay for medical care, you are always welcome to contact our billing office.