Insurance Basics: Home

In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Code Modifiers: How they Affect You

Doctors and insurers use standard codes for each medical service or supply. That helps them communicate about treatments and payments clearly.

Code Modifiers: How they Affect You
How Medical Supplies and Ambulance Rides are Billed

Medical supplies and equipment, such as bandages and wheelchairs, and ambulance rides are often listed separately on bills and Explanation of Benefits (EOB) forms.

Looking Up Costs for Behavioral Health Services

To look up the estimated costs for behavioral health services (including mental health and alcohol and/or drug services), go to our home page, fairhealthconsumer.org, and click on Medical and Hospital Costs.

Limited Health Plans: AHPs and STLD Plans

New rules have expanded access to two types of limited health insurance plans. They are association health plans (AHPs) and short-term, limited duration (STLD) health plans. Because they don’t have to follow the Affordable Care Act, these plans can cost less than regular health plans. But, they have limitations you should know.

What You Need to Know about Medicare

If you’re 65 or older, figuring out how Medicare works and when to sign up can be challenging. It can be hard to know what kind of coverage you’ll need. There are Part A, Part B, Part D, Medicare Advantage plans (Part C) and Medigap. There also are other complex terms to know. This article will cover the basics of what you need to know about Medicare.