Important health insurance terms

Premium: The amount you pay each month to have health insurance.

Deductible: The amount you have to pay out of your own pocket for covered health care each year before your insurance plan will start sharing the cost.

Coinsurance: A percent you pay for your health care costs, with your health plan paying the rest. This cost-sharing starts after you have reached your yearly deductible.

Copayments, copays: A fixed amount you pay each time you get health care services that are covered by your insurance.

Out-of-pocket maximum: The most money you would have to pay out of your own pocket in a year for covered health care, even if you got very sick.

Network coverage: Health care from the doctors, hospitals, pharmacies, and other providers that are in-network, meaning they work with your health insurance plan to offer care. As a plan member, you’ll get care at a lower cost.

Prescription drugs: Medicines your doctor orders to help treat an illness or health problem you have.

Formulary: A list of the prescription drugs your insurance plan will cover.

Preventive care: Medical care, such as screenings, that helps you stay healthy.

CPT code: A specific number (or code) for a health care service or test. Your insurance company uses this code to find out the costs of the care or service you receive.

Summary of tips to manage treatment costs

Barnes Jewish Hospital Financial Assistance: (314) 362-8400 or (855) 362-8400

Washington University Physicians Financial Assistance: (314) 273-0645

1. Talk with your doctor about the cost of your care.

   Ask questions such as:

   • My lab tests cost me so much. What are some ways we can lower the cost?

   • This drug costs me so much. Is there a cheaper drug I can take that works just as well? What are some other ways I can lower my cost?

   • What programs do you know of that could help me pay my health care bills?

   • Does the hospital or clinic offer care on a sliding scale (based on my ability to pay)? If so, how do I apply?

   • Does my insurance cover all parts of this treatment, including labs and imaging? Does any part of this treatment need to be pre-approved by my insurance?

2. Talk with your insurance company to find out which types of care are covered and to get cost estimates.

   • Keep track of your insurance papers and medical bills.

   • Write down your questions before you call your doctor or insurance company. If calling about a bill, have the bill number and date of service ready.

   • Ask your doctor for the CPT code of the procedure or treatment you’re going to get. Then call the insurance company to find out the cost for that procedure or treatment.

   • Call your insurance company to:

     • Find out how much the drugs you take will cost you. Have a list of the drugs when you call.

     • Ask if you can be assigned to a case manager so you can talk with the same person each time you call.

     • Check to make sure your doctors are part of your plan’s network each year. The plan network may change during the year. If your doctor leaves your plan’s network, call your doctor to find out how to continue your treatment with an in-network doctor.

3. Apply to get help with health care bills from local hospitals.

   • If you get care from Siteman Cancer Center, you will likely receive a bill from the hospital (BJC) and from your doctor(s) at Washington University. These will be 2 different bills even though they are for the same care. Call the numbers at the top of this page to apply for help with your bills. The sooner you apply the better.

4. Reach out to other places that can help you manage your costs.

   • Call your pharmacy and ask about different ways to buy your drugs, like getting 3 months of pills at a time. Or, sometimes buying your drugs from their website can lower the cost.

   • Call the drug company and ask if they provide any help with the costs of their drugs.

   • Call places that can help you pay for your premiums, copays, coinsurance, and prescription drugs. We have created a list of organizations on I Can PIC’s Resources page.