Maximizing Your Benefits By Understanding Your Policy
Insurance can sometimes be a complex issue. It has terminology unfamiliar to the average person and usually people don't want to take the time to understand it. By reading your health insurance policy you can start to understand and determines exactly what benefits you have and what its restrictions are. The best time to understand your benefits and its requirements is before you need to use them. You don't want to be wondering what your policy covers as you are being rushed to the hospital in an ambulance.
Begin by finding out about in network doctors versus out of network doctors. This is a big issue as more companies are moving to lower cost PPO and HMO type plans. You can save a lot of money if you use one of their doctors for the services you need and in some cases these services may even be free to you.
Each insurance company requirements are different. Certain procedures may be covered under one carrier but not the other. Some companies have pre-authorization requirements where the insurer needs to inform the insurance company of an impending procedure. After the information is provided, the insurance company will let you know what will be covered. If pre-authorization is not done, the entire cost of the procedure may be denied and the cost will be placed on the insurer for not following procedure. In cases where one is being rushed to the hospital a grace period of usually 24 hours is given so you can notify the insurance company that you or a dependent has been admitted into the hospital.
There are insurance companies which require a referral from your primary doctor before you can see a specialist. Having a specialist visit without the referral may result in coverage being denied. Your primary doctor may already be familiar with the requirements of your insurance.
Health care costs are rising and it's important to maximize the value of your coverage by understanding its benefits and knowing your responsibilities in order to obtain those benefits. Obviously, the best way is to read your entire policy, however, each company often have a one or 2 page Benefit Cost Summary that condenses the policy and highlights the most important aspects of the policy coverage.
Begin by finding out about in network doctors versus out of network doctors. This is a big issue as more companies are moving to lower cost PPO and HMO type plans. You can save a lot of money if you use one of their doctors for the services you need and in some cases these services may even be free to you.
Each insurance company requirements are different. Certain procedures may be covered under one carrier but not the other. Some companies have pre-authorization requirements where the insurer needs to inform the insurance company of an impending procedure. After the information is provided, the insurance company will let you know what will be covered. If pre-authorization is not done, the entire cost of the procedure may be denied and the cost will be placed on the insurer for not following procedure. In cases where one is being rushed to the hospital a grace period of usually 24 hours is given so you can notify the insurance company that you or a dependent has been admitted into the hospital.
There are insurance companies which require a referral from your primary doctor before you can see a specialist. Having a specialist visit without the referral may result in coverage being denied. Your primary doctor may already be familiar with the requirements of your insurance.
Health care costs are rising and it's important to maximize the value of your coverage by understanding its benefits and knowing your responsibilities in order to obtain those benefits. Obviously, the best way is to read your entire policy, however, each company often have a one or 2 page Benefit Cost Summary that condenses the policy and highlights the most important aspects of the policy coverage.
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