Georgia residents face a significant healthcare affordability burden. According to the 2022 Healthcare Affordability State Policy Scorecard, published by Healthcare Value Hub, Georgia ranked 44th out of the 50 states and Washington, D.C., for affordability in 2021.

The study revealed that from 2013 through 2021, the average healthcare spending per person in the state rose 37%, reaching $6,595 in 2021. Like much of the nation, Georgia residents continue to experience a rise in healthcare costs seemingly every year.

While a large portion of healthcare expenses get processed through health insurance plans, there is still a significant out-of-pocket burden on people themselves.

Below, we look at some of the most common health insurance claims in Georgia.

What Are Medical Claims?

What exactly is a health insurance claim? Put simply, every time a subscriber to a health insurance plan incurs a medical expense, the health insurance plan will process it first.

Every time you visit a doctor, for example, the doctor first sends the bill to your insurance company to process. The carrier then uses unique codes on the bill to determine which of the services are covered, how much is covered, whether any services are not billable and, finally, what amount you are responsible for paying out of your pocket.

The insurance company then sends what’s known as an explanation of benefits, or EBO, to you that breaks down all of this information. The doctor will receive a similar notice, and send you a bill for any outstanding amount you owe.

Most Common Health Insurance Claims in Georgia

The three major “buckets” of health insurance claims in Georgia are medical, dental and pharmacy.

Medical

Any visit to a general doctor, specialist or medical facility falls under the medical category. This includes primary care physicians, urgent care facilities, physical therapists, chiropractors, orthopedic care, and any emergency room visit or hospital stay.

Medical claims cover every doctor, essentially, that provides care for your body that doesn’t include your teeth or eyes — in most cases. The care they provide could be anything from preventative, to a giving a specific diagnosis, to performing a procedure. It also includes medical supplies, medical devices and transportation services for medical visits.

Dental

Any visit to a practitioner who specializes in your teeth will fall under dental care on your health insurance plan. This includes a routine dentist’s visit, to orthodontists and oral surgeons.

The care that is done at these visits can range from routine x-rays and cleanings, to having teeth pulled, root canals done or braces put on.

Today, dental care isn’t included in nearly as many health plans as it used to be. Many residents of Georgia have to either purchase dental insurance separately or pay out of pocket for all expenses related to dental care.

Pharmacy

Claims that fall under the pharmacy category include any prescription that was written by a doctor. When you pick up those prescriptions from a local pharmacy, those claims will be sent to your health insurance company and be applied to your pharmacy policy.

These prescriptions could treat ongoing issues such as high cholesterol, blood pressure or diabetes, or be “one-off” prescriptions such as antibiotics or pain killers.

Most of the time, your health insurance company will process these claims instantly, with you having to pay your personal responsibility at the pharmacy when you pick up the prescription. For mail-order prescriptions, you may receive a separate EBO and bill from the provider, just as you would for dental and medical claims.

There are some health insurance plans that also allow for reimbursement requests to be submitted for other items that can be purchased at the pharmacy. This might include over-the-counter medications, vitamins, first aid supplies and more.

Make sure to check with your health insurance plan to see if any of these items are covered under your plan.

Work with Beckham Ellis Insurance Group

Employers in Georgia have a challenging task of managing the increasing cost of health insurance plans — both for themselves and their employees — as expenses seemingly rise every year.

This can be a very difficult, if not impossible, job for employers to do on their own. That’s why it’s so beneficial to work with Beckham Ellis Insurance Group, which is an experienced health insurance benefits company.

Our experts can help your company design an attractive benefits plan that helps you attract and retain top employees, while also providing you options to potentially lower the cost of health insurance claims.