Do you really know what you are getting when you buy health insurance?
Your health insurance policy is an agreement between you and your insurance company. Your policy will list a package of medical benefits such as tests, drugs and treatment services that the insurance company agrees to cover either the partial or full cost of. These are called covered services. Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive.
When considering policies you must keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary while a medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.
Your insurance company determines what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company's choices may mean that the test, drug or service you need isn't covered by your policy.
Normally your doctor will be familiar with your insurance coverage so he or she can recommend health care that is covered by your current insurance plan. However, there are so many different insurance plans that it's not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.
Take the time to read your insurance policy. It's better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them. If you still have questions about your coverage, call your insurance company and ask a representative to explain it. Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
