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Understanding health care expenses

How insurance payments work

Your health plan is a contract between you and WellFirst Health to pay for medical services. Your insurer pays, and how much you pay will vary based on your plan. Typical plan costs can include a monthly premium that you pay each month to access your health insurance, as well as a system of cost-sharing that can consist of a copay, coinsurance, deductible or any combination of the three:

  1. Deductible is the amount you pay before your insurance covers any costs
  2. Coinsurance is when you’ve met the deductible amount, and your insurance will start splitting the cost of additional medical care with you. You only pay a percentage or part of the total cost of services and insurance will pay the rest.
  3. Copay is a fixed dollar amount for some care and prescriptions you pay each time you visit an office or refill that prescription. These all add to your maximum-out-of-pocket total or the dollar limit to your cost-sharing.

Cost of care

Knowing your care options before you need them saves you time and money. Learn more about the options for care, as well as associated costs.

Reading your Explanation of Benefits (EOB)

The EOB is not a bill. You’ll receive an EOB when using your health plan for covered care. The EOB lists the services used, the amount charged by the provider, and your financial responsibility to pay toward deductibles or coinsurance. Learn more about how to read the explanation of benefits document.

Prior authorization

Some medical services require pre-approval by WellFirst Health before receiving the service, commonly known as prior authorization. Our prior authorization process helps ensure you receive medically necessary care at the right time with the right provider. Learn more about the prior authorization process.

Preventive care

Preventive care is provided at visits that are usually with your primary care provider (PCP). Routine screenings, shots (vaccinations), and counseling to prevent illness, disease, or other health problems are some examples of preventive care. These preventive care services are covered without any ($0) out-of-pocket costs to members when received by an in-network provider. Visit our preventive care page for more information on what is covered.

Billing