Health insurance providers seem to make insurance plans and terms complicated to make it harder to question claims and decisions. After all, insurance providers are in the business of making money. While it might seem like your insurance representative has your best interest at heart, the main focus is on profiting off the insured. It’s important to understand the terms and conditions of your insurance, so you can protect your rights and get the most for your money. Read on for tips about understanding your health insurance plan.
First, get familiar with insurance plan terms
Before you can assess your unique plan, you need to know some terms common to the insurance world. One of the words you need to know is ‘premium’ which is the amount you pay your insurance company for health coverage. You’ll pay your premium on a monthly or yearly basis, depending on your plan.
Next, you are responsible for a ‘deductible’ which is the amount of money you’re required to pay out-of-pocket before your coverage applies. In general, the higher premium you play, the lower your deductible will be. Finally, a lot of insurance plans require you to ‘stay in-network’. That refers to a specific list of physicians and medical providers which are covered under your insurance. Knowing these terms will make navigating the insurance world much easier.
Next, know what’s in-network
Most insurance plans require you to stay in-network to make the most of your coverage. While many insurance plans will still pay for you to see a healthcare provider that isn’t in your network, they usually only cover a percentage of the cost which can result in a lot of out-of-pocket fees. It is important to familiarize yourself with which doctors, specialists, and even hospitals are considered within your plan’s network. In the case of emergency, choosing to go to an out of network hospital can result in skyrocketing costs on your part.
Learn the terms of your insurance plan
Each insurance plan with comes with a unique set of terms. The most important of these are usually what is and isn’t covered by your plan. In general, most insurance plans offer coverage for treatments that are deemed necessary. This includes things like yearly exams and regular treatments. Things can become costly quickly, however, when it is unclear whether a treatment is “required” or “medically necessary.”
These blurred lines between medically necessary and unnecessary are responsible for the majority of denied insurance claims. Often times you will need to have a conversation with your health care provider about the necessity of a particular treatment. It may be as simple as adjusting the claim for your particular treatment in order to receive the coverage from your insurance that you deserve. If you’re confused about what is or is not considered a medically necessary treatment, speak to both your insurance provider and your health care provider to see all of your options. This also applies to medicines which your doctor might provide. Insurance providers often cover only specific, approved brands which your doctor may or may not be aware of. When in doubt, speak to your insurance provider or your doctor about generic options or brands that offer the most coverage for your plan.
When in doubt, seek outside help
Sometimes it can be too challenging to understand insurance plans on your own. Oftentimes, this lack of understanding can result in incredibly high medical fees which can be crippling if you aren’t prepared. If you’re struggling to understand the unique terms of your insurance plan, don’t wait until you face a large medical bill to seek help. Go to The Doan Law Firm to find an expert attorney who can assist you with understanding your unique plan or help you petition a claim with your insurance. Everyone deserves access to healthcare, even if it means navigating complex insurance plans.
