If you have read through the fine print on your health insurance plan's documents, and you thoroughly understand everything that is and is not covered by your plan, congratulations! Be aware that you are one of only a small percent of people with health insurance who are completely aware of all of the terms, conditions and restrictions.
Health insurance - no matter what type of coverage you have - often has some major limitations, and you have to do a little homework to avoid surprises. Read on for a few limitations and other issues to watch out for.
Every detail counts
Some limitations are tiny and seemingly unimportant details, but they can nevertheless make it possible for your insurance company to deny your claim. For example, it is fairly common for a person to have a necessary medical procedure, submit a claim to the insurance company, and then find their claim denied.
Perhaps the person failed to obtain an authorization code before having the procedure, or perhaps the hospital filled out the paperwork incorrectly. Perhaps the codes used by the hospital were not exactly the same as the ones used by the insurance company. All of these details can make it possible for your claim to be denied.
Of course, you can always dispute the insurance company's ruling on any claim. It can be a time-consuming and tedious process, however, and your chance of success depends on many differnt factors.
Find out everyone who will be involved
Another limitation on health insurance that crops up more often than you would expect involves "extras."
Example: Your physician tells you that your medical condition requires surgery. Before you set up the date, you check your health plan to be sure the surgeon and the hospital are on their lists of approved providers. You think you have a clear understanding of your plan's hospital coverage. The operation takes place. While you are recuperating, you receive a huge bill for the services of the anesthesiologist, the physical therapist, and other specialists who consulted during your surgery and rehabilitation. It turns out that these "extras" are not covered by your insurance plan.
In this scenario, you could end up stuck with a bill for hundreds or even thousands of dollars that you had not anticipated because you incorrectly thought your health insurance covered everything.
You can't always dispute this type of charges; often times, the best you can do is to contact the named specialists and try to arrange some kind of payment plan. In the future, you can only avoid such charges by asking prior to the surgery exactly who will be involved, and make certain they are covered by your health insurance.
Watch for treatment limits
Limitations are often placed on the number of treatments that will be covered by your insurance. For example, if you need physical therapy after surgery, your plan may pay for only a certain number - perhaps ten sessions. If your surgeon says you require more than that, you msy have to pay for it yourself.
If you are not aware of this limitation, you may exceed the maximum number of sessions allowed by your insurance plan, and once again end up with large, unexpected bills.
Read carefully
When you choose an insurance plan, be absolutely sure to read it through carefully before you sign up. In addition, if you need to have any complicated or costly medical procedure, be certain that you consult your insurance plan in advance. Find out what is and isn't covered - down to the very last detail.
If you have any doubts, or questions, talk to someone at the insurance company before you make your arrangements. Be glad you have health insurance but also be knowledgeable about its limitations to get the most out of your plan.
