by: Peter Lenkefi

Health Insurance Coverage: What are ‘Covered’ Services?
Health insurance coverage is a contract used to determine medical
benefits that are covered, or not covered, between you and your
insurance provider. The insurance company, based on a fee that you
provide them on a regular basis, promises to pay health insurance
coverage on certain items or benefits listed in that contract. These
are called ‘covered’ services. ‘Covered’ services can include a wide
variety of things, such as implements, prescriptions, services (such
as massage), checkups, tests and/or research.

Your contract should also list all of the things NOT covered in your
health insurance coverage – these are items or services that you
will need to pay for out of your own pocket, should you require
them.

Health Insurance Coverage: What is a Medical Necessity? How is this
Different from Covered Services?
Just as it seems, a medical necessity is something that your health
professional has deemed a required service/ item that will affect
your health negatively should you decide not to purchase it.
However, just because your doctor tells you something is a medical
necessity does not mean your health insurance actually offers
coverage for it.

Since insurance companies decide what health coverage they will and
will not provide, you really have no leeway in this area.

Health Insurance Coverage: What Do I Do?
Most doctors try and keep themselves abreast as to what the major
insurance companies do, and do not cover when it comes to health
coverage. However, there are a LOT of plans out there, so this just
isn’t enough. So how can you avoid any nasty surprises during an
emergency?

Read your health insurance coverage. You’re better off knowing what
your health insurance company will, and will not provide coverage
for right off the bat. Then, if your doctor decides on a treatment
plan that isn’t covered, you can ask for alternatives that may be.
If there are questions regarding your health insurance coverage, do
not hesitate to contact the insurance company. Questions are good,
and they expect them.

Health Insurance Coverage: What Do I Do if Something I Need Isn’t
Covered?
The gross majority of what your doctor orders for you will be
covered in your health insurance plan. If you do get a treatment or
supply that isn’t covered, you can always challenge the health
insurance coverage. You may not be the only one who requires the
same type of service, benefit or item – so you’ll end up fighting
not just for yourself, but for others in the same situation.

Ask your doctor for their side, and use this in your claim. It may
not help in the end, but if your doctor is on your side, you may be
able to convince the health insurance company that coverage is
required.


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