Some of the best deals for health care coverage can be found with group health insurance plans, offered by employers and professional groups. Some medical service providers also offer plans for coverage that can save money on health care, but they may carry certain limitations that will have to be adhered to in order to realize the cost savings.
It is usually the administrator of the group health insurance schemes who carries out negotiations and settles prices for specific services with service providers for preparing a formal agreement to charge fee at a lower rate for professional services rendered to the intended beneficiaries. Insured people benefit because these fees are much lower than what they would have paid if they were not members of group health insurance.
There is a provision for cost savings for patients who are insured under group health insurance plan when they visit a network physician for treatment not covered under their group health insurance. Many doctors also offer similar discounts not covered by the insurance plan as they do for services covered by the plan. But there is a difference. The patients are required to pay the balance after services rendered.
Options and choices
Group health insurance plans are mostly designed in such a way that they will only pay the amount that was originally negotiated with member service providers. When a plan member visits a physician not in the plan, then the patient will be responsible for paying the difference between what the plan actually pays for the service and the fees that the physician actually charges. Let us take up a notional case. Suppose the group health insurance plan's agreed fee for the physician's clinic visit is $100 whereas the out of plan physician charges $200, the patient's personal liability will be $100 plus the patient's agreed co-payment.
Patients can save money visiting physicians on the plan, but when employers switch group health insurance plans, there may be times when the family physician does not belong to the new plan. Instead of being forced to choose a new primary care physician, the patient continues to visit their previous doctor, incurring the additional costs out of pocket.
In most group health insurance plans prescription drugs are also included along with a co-payment being required for each prescription. Some allow up to a 90-day supply to be obtained from mail-order pharmacies at the same co-payment as the monthly supply from their regular pharmacy. This saves money from paying the coo-payment for each prescription once every three months instead of monthly on maintenance drugs.
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