Family Doctor 2008

working with your doctor HEALTH INSURANCE Understanding By Anne L. Rubeck Become familiar with your health insurance policy to avoid unpleasant surprises. 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. This is often the case for more expensive tests like CT and MRI scans, surgery or visits to specialists. ● For some kinds of covered care, there are your health insurance Coming to grips with terms in your insurance plan such as “covered services” and “medical necessity” can give you a headache. Read on to clear up the main causes of confusion. limits on the number of treatments that are covered per year. This often applies to mental health treatment as well as physical, occupational or speech therapy. ● 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. Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn’t covered, or you get a prescription ﬁlled for a drug that isn’t covered, your insurance company won’t pay the bill. You can still get the treatment your doctor recommended, the health insurance same as a medical beneﬁt. A medical necessity is determined by your doctor. A medical beneﬁt is something 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. This is because insurance companies base their policies on what is generally good for most people. Insurers can’t possibly know all the combinations of treatments and services that will be beneﬁcial for each individual. So what should you do to avoid unpleasant surprises? Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it’s not possible for him or her to know the speciﬁc details of each plan. By understanding your insurance coverage, you can help your doctor choose medical care that is medical covered in your plan. Consider these tips: ● Take the time to read your insurance policy. N avigating but you will have to pay for it yourself. If your insurance company denies your claim, you have the right to appeal the decision. Before you decide to appeal, be familiar with your insurance company’s appeal process. This should be discussed in your plan handbook. Also, ask your doctor for his or her opinion. If your doctor thinks it’s right to make an appeal, he or she may be able to help you through the process. Anne L. Rubeck is an editor living in Overland Park, Kan. maze can be confusing and frustrating. There are many types of plans that cover — or don’t cover — a wide variety of health services. How can you be sure of what’s covered by your health insurance policy? Here are the basic policy areas that a lot of people have questions about. Covered services. These are outlined in the package of medical beneﬁts described in your policy. These services can include tests, drugs and various treatments. Your policy also lists the kinds of services that are not covered by your insurance company. As you’ve probably discovered, you have to pay 100% for any uncovered medical care that you receive. You may still have to pay for part of a covered service (called a co-payment) or a percentage of the total cost. Medical necessity and beneﬁt. A medical necessity is not the ADDITIONAL INFORMATION American Academy of Family Physicians http://familydoctor.org/688.xml Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/ Agency for Healthcare Research and Quality http://www.ahrq.gov/consumer/insuranceqa/ 16 familydoctor 2008 http://familydoctor.org/688.xml http://www.cms.hhs.gov/ http://www.ahrq.gov/consumer/insuranceqa/

Table of Contents Feed for the Digital Edition of Family Doctor 2008

Family Doctor 2008 Foreward Introduction Contents What Do You Want From Health Care? Confident Communication Need a New Doctor? Understanding Your Health Insurance OTC Safety as Simple as 1-2-3 The Fight Against Resistance Drug Interactions Prevention is Better than Cure Hitting a Home Run 'The Herbalist Will See You Now' Healthy Eating to Boost Your Heart and Health Exercise: The Elixir of Life Back from the Brink Taking Control Up All Night Vitamins and Minerals 101 Allergies: Combating the Causes Protect Yourself From Colds and the Flu Diabetes: Assessing Your Risk Dealing with Diabetes The Cholesterol Count Getting a Grip on Hypertension Facts About CKD Banish the Burn Easing the Pain Stop the Pounding Urinary Tract Infections: Common and Preventable Skin Essentials The ABCs of COPD Impotence: Tackling the Old Taboo Taking Responsibility for Your Health Prostate Cancer Screening: Is it For You? Protecting Your Prostate Heart Disease and Women: Know the Risks Birth Control to Suit You Maneuvering Through Menopause Help for PMS Infertility: Problems Having a Baby Preventive Health: What Women Need to Know Pregnancy: Taking Care of You and Your Baby Eating for Two Postpartum Mood Disorders The Basics of Breast Milk Newborn Screening Tests: Possible Lifesavers Common Newborn Conditions Childhood Vaccines: Why They're Necessary Food Allergies: The Facts Facing Your Acne Raising Grades Staying On Your Feet Age Gracefully: Take Care of Your Bones Battling Osteoarthritis Tackling Anxiety Beating the Blues

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