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Our concierge team answers your in-network and out-of-network insurance questions

Our concierge team answers your in-network and out-of-network insurance questions

Five Faces

When you’re sick you worry about your health, but you may also worry about your health insurance—what does it cover, how much will you pay out of pocket, can you see a good doctor, who can help answer your questions?

3 things to know that can take some of that worry away:

  1. CarePoint Health is now in-network with Horizon Blue Cross Blue Shield of New Jerseyinsurance. If you have Horizon Blue Cross Blue Shield insurance, you’re now covered as in-network at our hospitals, and as Tier 1 with CarePoint Health Medical Group doctors. That means you’ll have lower out-of-pocket costs to award-winning health care in Bayonne, Hoboken and Jersey City.
  1. CarePoint Health does not restrict access to care based on your insurance benefits. A list of additional in-network insurance carriers with Bayonne Medical Center, Christ Hospital in Jersey City, Hoboken University Medical Center and CarePoint Health Medical Group doctors can be found here.
  1. Our concierge service offers you help—at no charge—with things like insurance questions, as well as choosing the right doctor, faster appointments and more with a simple phone call to 201.884.5329.

Your top 10 health insurance questions answered.

Our concierge team is always available to answer your questions and work with you and your insurance company. Below are some of the most common questions we hear about insurance coverage.

  1. What is the difference between in-network and out-of-network providers?A provider network is a set of doctors, hospitals, nurse practitioners, therapists and other clinicians that are part of your health insurance plan.

    An in-network provider or hospital is one who has contracted with your health insurance company to provide services for specific pre-negotiated or discounted rates. An out-of-network provider or hospital is one who has not agreed to the discounted rates and has not contracted with your health insurance plan.

  1. What does Tier 1 mean? It is more cost effective for you to receive care at a hospital, doctor or medical group that is ranked in a more preferred tier because you will have lower co-payments and/or deductibles. Tier 1 offers you the highest benefit level with the least out-of-pocket expense.
  1. Why do health plans use provider networks? Health plans negotiate better prices with the doctors and hospitals in the network. Lower prices from network providers mean you pay less in insurance premiums and other charges.
  1. How do health plans select providers for their networks?Health plans look for providers that deliver safe, efficient, quality care that is affordable. They evaluate doctors and hospitals for quality and safety before they are included in the network.
  1. How do deductibles work? A deductible is the amount you owe for covered services each year before your insurance plan starts covering the bill. For example, if your annual deductible is $1,000, you need to spend $1,000 on health care services before your insurance company starts paying a percentage of the cost.
  • The higher your deductible, the lower your premium. A premium is the amount you pay for your health insurance plan. If you are employed, you may pay this amount directly out of your paycheck every pay period.
  • A deductible helps lower your premium
  • Some plans have different deductible levels
  1. How do copayments work? Depending on your insurance coverage, you may have to pay a fixed fee at the end of a doctor’s appointment or other covered health service. For example you may have a copay of $30 for a primary care doctor visit or a $50 copay when you see a specialist.
  1. How does coinsurance work? Coinsurance, like copayment, is a form of cost sharing between you and the insurance company. Unlike copays, which are a flat fee, coinsurance is a percentage of costs that you must pay after you meet your deductible. For example, you may have a deductible of $1,000 before your insurance will cover 80 percent of the charges, leaving you responsible for the other 20 percent of the bill.
  1. Why is it important to see an in-network doctor or specialist? If you want to get the most out of your coverage for the least out-of-pocket cost, it is important to find a doctor in your plan’s network.
  1. What if there’s an emergency and I go to a hospital outside my network? New Jersey law mandates that New Jersey insurance companies always cover emergency room services as in-network,* including hospital stays. That means you are only responsible for your deductible or out-of-pocket expenses, no matter where you receive care.

    This is to protect patients in a medical emergency to ensure they receive access to the closest, most appropriate care in the event of a medical emergency, regardless of network status.

  1. How can your concierge team help me get the most out of my health plan coverage?  When you sign up for our free concierge service we will be able to:
  • Verify your insurance and explain what type of coverage you can expect.
  • Obtain referrals and pre-authorizations to assure you’re covered.
  • Work with your insurer to help answer your insurance questions.

Your health is important—and it shouldn’t be subject to insurance worries. Our team is here to help, so you can concentrate on feeling better.

*Not all plans issued in the state of NJ are governed by NJ law. Certain employer sponsored plans may fall under Federal ERISA law. Coverage for emergency services for these plans should be clearly defined in your summary of benefits. If you have any questions regarding your coverage, we encourage you to contact your insurance carrier.


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