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How To Understand What Your Health Insurance Covers

The Website: FamilyDoctor.org from the American Society of Family Physicians has put out a good article on understanding what health insurance covers. You health insurance policy is a contract between you and a health insurance company. It outlines what coverage you have, and under what circumstances you will be covered.

The first point the article makes, and one you need to understand is this: Keep in mind that a medical necessity is not the same as a medical benefit. Your doctor may decide that you need a medical procedure or medicine, and you insurance may not cover it. Most of the time your treatment should be covered by a major medical plan, within the limits of deductibles and copays, but sometimes it will not be.

If your health insurance claim is denied, you can certainly appeal the decision. The health insurer’s appeal process should be outlined in documents that came with your policy, or you should be able to obtain them with a phone call to customer service. Start with the health insurer first, and see if a mistake was made. Sometimes bills are miscoded, and can be changed at a very low level. If this doesn’t work, try an appeal.

As a last resort, consider your state insurance department or consulting an experienced health insurance lawyer for advice.

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