Doctor Insurance Coverage Questions

IU Health participates in most major health plans in Indiana. Please review your health plan provider directory and/or consult with your insurance company to confirm coverage.

When you arrive for your appointment, please present your current health plan identification card. In addition, you may send IU Health your updated information at any time by using the links provided once you log in to your My Services account.

Health Maintenance Organizations (HMOs) require a patient to select a primary care physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors, and other medical professionals, that, as a patient, you must use in order to be covered for that service.

Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors, and other medical professionals. When patients utilize healthcare providers within the network, they receive a higher financial benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often with greater out-of-pocket expense(s) for you.

If you receive your healthcare services from a hospital, physician, or other healthcare provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians, or other health care providers who do not participate in your health plan may be referred to as "out-of-network."

Your benefit book or provider directory should have this information. If not, call the customer service phone number listed on your identification card.

If you did not contact your primary care physician or your insurance company before you came to the emergency room, you will need to contact them within 24 hours of receiving services to explain the circumstances and ask for authorization.

One or more of the following may apply:

• The service you received was not covered under your plan.
• You did not provide the correct insurance information at the time of service.
• The service you received was from a physician outside your plan's network.
• You were not covered by the plan at the time of service.

Consult your insurance company. If you have further questions about your account, you may also contact Patient Financial Services.

What is an EOB?

An EOB, or Explanation of Benefits, is a statement sent that provides necessary information about claim payment and patient responsibility amounts.

Some of the information you may see on an EOB are:

• Provider of care
• What services were covered
• What amounts were paid
• What discounts/adjustments the provider is contractually obligated to write off
• If any of the services were denied and why
• Your deductible and/or co-insurance and/or co-payment amounts

Sometimes an EOB is also called on EOP, or Explanation of Payment.