|
ArticlesHealth Insurance Policy: Are You Covered?
Date Added: March 12, 2010 01:43:16 AM | | Inderstanding conditions in your insurance, such as "covered services" and "medical necessity" can give you a headache.
Navigating the health insurance maze can be perplexing and frustrating. There are many types of plans that cover – or do not cover – a wide selection of health services. How can you be sure of what is covered by your health insurance plan.
• Covered services are featured in the package of medical benefits described in your insurance policy. These services can include screening, medications and various treatment methods. Your insurance also lists the kinds of services that are not covered by your insurer. As you've possibly discovered, you have to pay 100% for any uncovered medical care and treatment that you get. You might still need to pay for a part of covered treatment 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 set by your physician. A medical benefit is something that your insurance plan has agreed to cover.
So what should you do to avoid unpleasant surprises? Your doctor will try to study your insurance policy so he or she can provide you with covered care. However, there are so many different plans that it isn't possible for him or her to be well-aware of specific details of each policy. By understanding your coverage, you can help you doctor opt for medical assistance that is covered in your policy. Below are a few recommendations:
• Read through your insurance policy. It is better to be well-aware of what your insurer will pay for before you receive a service, get tested or fill a prescription. Some kinds of care might have to be approved by your insurance company before your doctor can provide them. This is ordinarily the case for more costly screening, like CT and MRI scans, surgery or visits to specialists.
• For some forms of covered medical care, the number of treatment covered yearly is limited. This often applies to mental health treatment and physical, occupational and speech therapy.
Most treatment options your doctor advises will be paid by your insurance, but some might not. When you receive medical treatment that is not covered or you have a prescription filled for a medicine that is not covered in your insurance, your insurance company will not pay the bill. You can still receive the medical treatment your doctor recommended, but you will need to pay for it yourself. |
|
