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Become Familiar With Your Health Insurance Plan |
| Date Added: March 18, 2010 04:54:00 AM |
| Author: sunpport89 |
| Category: Reference |
| Coming to grips with conditions and terms in your insurance policy, such as "covered services" and "medical necessity" can give you a headache. Navigating the health insurance maze of regulations can be puzzling and frustrating. There are many kinds of plans that cover – or don't cover – a large scope of health services. How can you be sure of what's covered by your health insurance policy. • Covered services are outlined in the package of medical benefits described in your policy. These services can include test, medications and various treatments. Your policy also specifies the types of services that aren't covered by your insurer. As you have probably discovered, you need to pay the total cost of any uncovered medical assistance that you receive. You may still have to pay for a part of a covered service or a percentage of the total cost. • Medical necessity and medical benefit: A medical benefit and a medical necessity are different issues. A medical benefit is determined by your physician. A medical benefit is something that your insurance policy has agreed to cover. So what should you do to stay away unnecessary surprises? Your doctor will try to be familiar with your insurance policy so he or she can offer you covered medical treatment. Nonetheless, there are so many different plans that it isn't possible for him or her to be well-aware of some details of each plan. By coming to grips on your insurance policy, you can help you medical practitioner opt for medical treatment that is covered in your plan. Here are several tips: • Read your insurance policy. It is better to be well-aware of what your insurance company will pay for before you receive a service, get screened or fill a prescription. Some forms of care may need to be approved by your insurance company before your doctor can provide them. This is frequently the case for more pricey screening, like CT and MRI scans, surgery or visits to specialists. • For some types of covered care, there are limitations on the number of treatment that are covered annually. This ordinarily applies to mental health treatment and physical, occupational and speech therapy. • If you still have questions about your policy, call your insurer and ask a representative to explain it. • Remember that your insurer, not your physician, decide on what will be covered for and what will not. Most treatment options your medical practitioner advises will be covered by your insurance, but some may not. When you get medical care that is not covered or you get a prescription filled for a drug that is not covered in your policy, your insurer will not pay the bill. You can still get the medical care your doctor recommended, but you will have to pay for it yourself. |
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