Health Insurance - What is it and What
Should I Look For?
What is a health insurance policy and what should you look for? Basically,
a health insurance policy is an agreement between you and your health
insurance company. The health insurance policy lists a package of medical
benefits. These benefits will usually include tests, drugs and treatment
services for your medical needs. A health insurance company agrees to cover
the cost of the benefits that are listed on the policy. The policy will also
list the services that are not covered and the type of services you may have
to pay for out of pocket.
Before you sign up with a health insurance plan, make sure you understand
what you are getting in terms of your benefits and what your
responsibilities are. Take the time to read the entire health insurance
policy. Check to see what the health insurance company will cover and if
it’s adequate for your needs. Some medical procedures or treatments may have
to be pre-approved by your health insurance company before your doctor can
start any type of service. Some policies will provide for the cost of
prescription drugs and allow routine or annual check-ups. Others may
require you to buy a separate rider or may exclude drugs altogether. It’s up
to you to understand any exclusions your policy may contain.
If you don't understand your health insurance policy, ask the company to
explain everything to you in detail. It’s important to know that your doctor
does not decide what services will be paid for or not. This is what the
health insurance company decides solely. Chances are that most of the
services your doctor recommends will usually be covered. Occasionally a
doctor will indicate a course of treatment, order tests or prescribe
medication that is not covered and the health insurance company will not pay
the bill. This is what is called “denying the claim” and you are then
responsible for the bill. It’s not unheard of for a health insurance company
to second-guess a doctor’s recommended treatment after the fact, so make
sure you are aware of your policy’s limitations You don’t want to receive a
large medical bill that is not covered by your policy.
Another consideration is how extensive is the health insurance company’s
network of participating doctors and/or hospitals. It doesn’t do you any
good to have a health plan that your doctor doesn’t participate in or won’t
accept. If you don’t have a doctor yet, check to see that your particular
needs will be met, for example, a pediatrician for your child or a heart
specialist for yourself.
Health insurance policies are reasonably easy to understand if you take the
time to read your entire policy. If you do not understand a term on the
health insurance policy, check the company’s website for a FAQs section or
do a general search online and get explanations and information on
unfamiliar terminology.
Getting all the information and research done before you sign up for a
health insurance policy can save you both time and money in the long run.
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