Understanding Health Insurance Coverage: A Primer
Peter Lenkefi
Health Insurance Coverage: What are ‘Covered’ Services?
Health insurance coverage is a contract used to determine medical benefits
that are covered, or not covered, between you and your insurance provider.
The insurance company, based on a fee that you provide them on a regular
basis, promises to pay health insurance coverage on certain items or
benefits listed in that contract. These are called ‘covered’ services.
‘Covered’ services can include a wide variety of things, such as implements,
prescriptions, services (such as massage), checkups, tests and/or research.
Your contract should also list all of the things NOT covered in your health
insurance coverage – these are items or services that you will need to pay
for out of your own pocket, should you require them.
Health Insurance Coverage: What is a Medical Necessity? How is this
Different from Covered Services?
Just as it seems, a medical necessity is something that your health
professional has deemed a required service/ item that will affect your
health negatively should you decide not to purchase it. However, just
because your doctor tells you something is a medical necessity does not mean
your health insurance actually offers coverage for it.
Since insurance companies decide what health coverage they will and will not
provide, you really have no leeway in this area.
Health Insurance Coverage: What Do I Do?
Most doctors try and keep themselves abreast as to what the major insurance
companies do, and do not cover when it comes to health coverage. However,
there are a LOT of plans out there, so this just isn’t enough. So how can
you avoid any nasty surprises during an emergency?
Read your health insurance coverage. You’re better off knowing what your
health insurance company will, and will not provide coverage for right off
the bat. Then, if your doctor decides on a treatment plan that isn’t
covered, you can ask for alternatives that may be.
If there are questions regarding your health insurance coverage, do not
hesitate to contact the insurance company. Questions are good, and they
expect them.
Health Insurance Coverage: What Do I Do if Something I Need Isn’t Covered?
The gross majority of what your doctor orders for you will be covered in
your health insurance plan. If you do get a treatment or supply that isn’t
covered, you can always challenge the health insurance coverage. You may not
be the only one who requires the same type of service, benefit or item – so
you’ll end up fighting not just for yourself, but for others in the same
situation.
Ask your doctor for their side, and use this in your claim. It may not help
in the end, but if your doctor is on your side, you may be able to convince
the health insurance company that coverage is required.
For more more information about health insurance coverage please visit
http://www.1health-center.com/articles/Health-Insurance-Coverage.php
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