With my old insurance I could go see my Doctor and just pay my co-pay. How does your plan work whenever I want to see my Doctor?
With the Defined Benefit plans from Philadelphia American (PALIC) the act of going to the Doctor will be very similar to going to the Doctor with a regular major medical plan with one big exception. The biggest difference is that there isn’t any money due at time of service. No co-pay! You simply show your insurance card at the Doctor’s office and they file the claim with PALIC. If your plan is scheduled to pay more than want is owed then you actually get a check from the company for the over pay! That’s the opposite of a co-pay! The company pays you! However, any difference between what the company pays and what is owe will be the client responsibility.
You also have the option the pay for your visit out of your own pocket and file the claim with PALIC yourself. The company will reimburse you the same amount that they would have paid the doctor for the visit. Most providers will give you a significant discount for paying with cash instead of filing with insurance. Paying with cash will also give you the option to see any doctor you want. There are no networks when paying with cash!
If you have more questions about how these plans work or for some claims examples please don’t hesitate to call or email us at Stockett and Associates.