The Difference between Standard and Specialist Care

Health insurance doesn’t guarantee the same prices for every level of care. As you likely know, treatment involves different levels of care based on your need.

For example, you may visit your primary care provider for the flu or other common ailments. But, if you suffer from kidney or have a heart conditions, you may need to see a nephrologist or cardiologist. These doctors are specialists who practice in one specific area of medicine.

Specialist services have different impacts on your health insurance costs.

General Pricing Options for Health Insurance

Different types of plans come with different payment options.

Most plans have deductibles. You pay for 100 percent of the cost of your care up until you reach that deductible. However, certain treatments always have coverage even before you meet the deductible.

Coinsurance plans mean you basically split the care cost with your insurance company. You will pay a certain amount of the bill while your insurance covers the rest.

Other health care plans come with copays. You pay a small fee (the copay) for medical services. The insurance covers the rest.

Health care plans usually offer a mixture of coinsurance and copays.

How Specialist Care Affects Costs

Because you need a specialist, your care costs may be different from those of standard care.

If you pay using coinsurance, you will likely pay the full cost of specialist care up to the deductible cost. If you have a copay, then you will still pay a copay for specialist care. Copayments usually are nominally higher payment for specialist care than for standard care.

Always check with your care provider. The Affordable Care Act requires insurers to fully cover some aspects of care. For that reason, you may not have to pay as much as you assume. Your doctor can give you a good idea about your cost responsibility before you receive care.

Always make sure that you know what care your insurance plan covers. Some specialist care may not have any coverage at all. Standard specialist care like cardiology and oncology usually have full coverage. However, insurance may not cover some specialists like physical therapists.

Additionally, make sure that you are seeking treatment within your network. Some insurance companies don’t cover certain providers. They may charge you a higher rate if you see a specialist outside your network. They may not even cover your medical payments.