Who should you contact if you have questions about your health insurance coverage?

Choosing the right health insurance plan is no easy feat. The American healthcare system has earned itself a reputation for numerous reasons; therefore, as a consumer, you must make a well-educated and wise decision about managing your healthcare needs.

Who do you go to? A health insurance provider is your one-stop-shop for answers to all your insurance coverage related queries.

Once you have narrowed down your options for healthcare providers, you must sit a discussion with them in which you ask them about anything and everything.

Are you feeling confused about what to ask them? Worry not.

The following is a list of the ten most frequently asked questions related to health insurance coverage.

Let us walk you through them.

  • What type of plan is it?

It is essential to find out whether your health insurance plan is a managed care system or an indemnity health plan.

The former refers to either a health maintenance organization or a preferred provider organization.

Managed care systems entail minimal out-of-pocket expenses. With a health maintenance organization, you are required to pay a fixed monthly fee for the healthcare services you wish to avail of. However, you can only visit a doctor who is under a contract with the said health maintenance organization.

As for preferred provider organizations, you receive a discount if you consult a physician who is under contract with the organization. You can visit a doctor who is outside the preferred provider organization system, but obviously, you will be required to pay more there.

The latter, i.e., indemnity health plans, are also referred to as fee-for-service plans. In this system, you pay a percentage of the medical costs, and your insurance provider pays for the remaining portion. Indemnity plans have no restrictions when it comes to choosing a doctor or healthcare facility. You can consult whomever you want to.

  • How much am I required to pay for healthcare?

It is essential to inquire about the amount you are required to pay as a premium. Ask your insurance provider if you will be charged a small flat service fee or a co-payment for healthcare services.

Some plans feature a deductible instead of a premium. The deductible amount is the amount you have to pay before your health insurance plan starts to cover any medical costs.

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Be sure to ask your provider about the percentage of costs that the plan will cover once the deductible has been paid.

  • Will I be able to consult my current doctors?

Some people are open to anyone when it comes to receiving health services or seeking consultations. Others, however, find themselves more comfortable consulting with specific doctors and healthcare facilities. It is critical to ask if there are any limits when it comes to choosing your hospital or doctor.

It is prudent to request the list of doctors and hospitals associated with the plan so you may decide which plan suits you and your needs best.

  • What benefits are included in my plan?

Health insurance comes with benefits. Needless to say, everyone wants the best offer available in the market.

Find out if your health insurance covers vision care, dental care, or any other special services that you may require. People often tend to forget about prescriptions, so be sure to inquire about those as well.

Additionally, it is a good idea to find out about the benefits that are not included in your plan.

  • Does my plan cover routine exams?

Routine exams include routine checkups, pap smear tests, blood work, mammograms, immunizations, etc. Since routine exams are more frequent, it is always a good idea to find out if your plan covers their costs or not.

  • Will I have to inform my doctor before going to the ER?

Emergency care generally does not come with any set conditions. However, some health insurance plans require you to inform your doctor within 24 hours of visiting the hospital ER, or the costs will not be covered.

You may want to be a little careful with this once since emergency care is not cheap, and a small misunderstanding could potentially cost you a lot of money.

  • Are there any restrictions on pre-existing conditions?

Pre-existing conditions, in this case, refers to chronic conditions. Some health insurance plans do not cover costs related to chronic medical conditions. Some offer coverage, but after a certain time period has passed.

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Ask your health insurance provider if they provide coverage for chronic conditions. If yes, be sure to find out for how long the coverage is excluded.

  • Can I avail my coverage if I am traveling?

Often health situations arise when you are away from home. In such cases, the lack or presence of a health insurance plan can make a huge difference.

Be sure to find out if your plan covers healthcare costs amidst travel, and if so, how do you get the expenses reimbursed when you are back.

  • Is the insurance provider stable financially?

When picking out an insurance provider, you must do some background research. Sure, we all want affordable health coverage. However, it is crucial that you do your homework before you decide where to spend your money. You cannot get lured into a great deal with low premium only to find out that your plan is not a good one.

Inquire about the company you are taking into consideration. See how long they have been in the business and inquire about their clientele. If you see favorable results, go ahead with your decision.

  • How does the company deal with claim disputes?

Every insurance provider has a procedure devised to appeal for denied claims. Some require you to take the dispute to an arbitrator or an independent entity who will listen to both sides and then proceed to make a decision regarding the claim.

Be sure to find out about the provider in question’s average turn-around time for resolving disputes over denied claims.

Parting Thoughts

Do not rush into selecting the cheapest health insurance plan in front of you. Instead, we suggest you take your time with the decision. Talk to others around you and look for recommendations. If you have any individual concerns, be sure to present them to any potential health insurance providers.

As a customer, it is your right to ask any and every question that you want to ask. List your priorities and find the best insurance plan in the market.

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