Insurance

Dr. Spencer is a PPO provider for the following insurance companies:

1. BCBS of Illinois
2. PHCS
3. Unicare
4. Aetna
5. Cigna
6. Medicare Part B

One of the first questions that patients will typically ask is: How much will my insurance cover?

This is a tricky question because not many people understand how their insurance works. Most PPO plans have a deductible that rolls over every year (usually January 1). This means that before your insurance company will pay for any services, your deductible must be met. Deductibles typically range from $200-$1000 depending on your coverage. Furthermore, your insurance will usually only cover a percentage of the doctor's fees. Again this depends solely on your plan and can range from 75%-100%.

So ... What does this mean?

It is usually in your best interest to go to a doctor who is in your provider handbook as this will mean less money out of your pocket. So let's just use round figures to explain this. Hypothetically, you go to your doctor whose bill is $100 for that day. Now your insurance will not cover any of that as your deductible must be met first, so let's assume that your deductible has been met.

Now for the $100 charge your insurance and the provider have agreed that the insurance will pay for $55 of the $100 and therefore the other $45 will be written off as a 'provider discount'. Now for the $55 your insurance has agreed to pay 90% as the other 10% is what is considered co-insurance. Therefore, your insurance will pay $49.50, leaving you with a balance of $5.50.

Here at Physicians Plus Berwyn - Ltd. we typically bill your balance on a monthly basis. Remember that you should always look at your EOB (explanation of benefits) as this will indicate what services were covered and what balance you may possibly have.