You should expect to pay anything above the Benefit Amount when getting care. Some providers will charge less than the Benefit Amount, and others will charge more (known as balance billing). Prices can vary and we always recommend shopping to compare prices from healthcare providers BEFORE you get care. Always ask for procedure codes for the expected medical services so you can verify your estimated Benefit Amount in the member portal.
For office visits and other routine care, we recommend you use the Sidecar Health ‘Estimate care’ tool found in the member portal to look up the Benefit Amount. This way, you’ll always know what your plan pays, and you can compare that amount to what your doctor will charge before deciding where to get care.
For complex or costly care (i.e. surgeries, procedures), request a “pre-bill” or a “good faith estimate” from your provider and upload it as a new expense on the member portal.
Pre-bills help to:
- Provide clarity around your benefits and coverage.
- Authorize the Sidecar Health VISA benefit card to exceed your swipe limits.
- Protect against charges for an unplanned procedure during a planned event.
- Initiate Provider Location Assistance (PLA), if needed. This is where the member care team will help find other providers near you within the Benefit Amount.
Pro tip: Allow at least 5 business days for pre-bill processing before your scheduled procedure.
If you experienced an emergency, don’t worry, you’re fully covered. Sidecar Health pays emergency room providers directly and your out-of-pocket costs are capped. Call Member Care at 855-282-0822 to help navigate emergency room billing.