Gynecologist Meeting with PatientMost health insurance will help to cover visits to a gynecologist. However, coverage plans differ greatly, not only from one company to another, but also from one member to another. This is why you should always read your individual health plan thoroughly to determine whether or not you have coverage.

Even if a gynecologist is covered under your plan, there are certain details of which you should be aware. If you assume that gynecology is covered, you may find yourself presented with a big medical bill for which you are responsible. If you have any doubts or questions about your plan, it is usually a good idea to speak with an insurance representative directly and take notes about your conversation.

Do you need a referral?

A gynecologist is considered to be a specialist, and many times a referral will be necessary in order for your health insurance to cover the visit. Check with your coverage benefits and if a referral is necessary, you will need to first make an appointment with your general practitioner.

He or she will then need to determine whether an appointment with a gynecologist is necessary.
Some plans cover visits to a gynecologist without a referral. If this is the case, you can make an appointment without visiting your regular doctor. If you do, make sure that the gynecologist is covered by your plan.

Are certain gynecologists covered by your plan?

With many health insurance plans, there are approved doctors that you are able to visit. Some plans will only cover care under those doctors, while other plans will give better benefits if you choose off of the approved list.

Find out what your plan restrictions are in terms of specific gynecologists. If you want the best coverage you should choose a gynecologist from the list. If you have a favorite gynecologist that you like but she isn’t on the list, you will have to decide whether it is worth paying for the visit out of your own pocket.

Are certain tests covered and are there limits?

Once you determine that gynecology is covered by your insurance plan, your next step is to find out exactly what is covered. It may just be the office visit and routine procedures such as a pap smear. If cancer is a concern, see if your plan covers cancer screenings.

Although some procedures, such as mammograms, are covered under wellness visits, there are often specific terms and limits associated with them. Some only cover these if you are a certain age, such as 40 years old or older. You may also be covered for only one a year or one every other year, which means that if you need a follow up test you will be responsible to cover the costs for it.

Is family planning covered?

One of the reasons you may be visiting a gynecologist is to get advice about birth control. Some insurance plans will cover this, while others will not. Birth control pills are often not covered by prescription plans, even if your gynecologist recommends them.

Also, you may be visiting a gynecologist if you are having difficulty getting pregnant. Fertility treatments are often not covered by insurance, especially if you have a more basic plan. These treatments can be very pricey, so if finances are a concern you will want to double check if your plan covers any of it.

What other insurance terms should you be aware of?

Reading insurance plans can be very confusing and there are pages and pages of information that you need to digest and understand. Reading them may even cause you to give up and not read all of the details. This would be a big mistake on your part, however.

Benefit coverage plans give you a lot of information that gives you a good idea as to what you are responsible for financially and what your insurance company will cover. After you have determined what benefits are covered, look at the deductible for which you are responsible. This needs to be met by you before any money is paid by insurance.

Keep in mind that the deductible is a total of all money spent by you for medical care, so if you have met the amount from other care you have received, then your gynecological care should be covered from the start.

Look at your co-pay and or coinsurance. The co-pay is the amount you are responsible for at the time of the visit, while coinsurance is the percentage of the total amount for which you are responsible. See if there is any limit to the amount that either your insurance company will pay for or that you have to pay for.

Also look for any exclusions to your plan, as these can affect a number of care procedures that you may need but will ultimately have to pay for yourself. If you have any doubts as to whether your insurance will cover your visits and procedures, contact the company directly.