I have been trying to figure this out for my coverage. I am looking for the out of pocket expense at time of service. Any guidance on this would be greatly appreciated!
When it comes to healthcare, the best way to maximize the most from your benefits, is to stay within the Humana network.
Based on your specific plan benefits, a preventive, in-network colonoscopy screening is covered at 100%; including the physician fees, facility and anesthesia. There is no cost to you.
With that being said, if the physician determines that your procedure is considered a diagnostic (medically necessary) colonoscopy, then the services (facility, physician and anesthesia) would be covered at 80% after your $1000 deductible is met. The in-network out of pocket annual limit is $5000.
So, be sure to ask your doctor why a test or service is ordered. As you can see, your benefits can be different for routine services versus diagnostic services. By asking your doctor why a test or procedure is ordered, you will know whether to expect the claim for the services to be covered under your routine services benefit or your diagnostic services benefit.
Retrieving data ...