The majority of the detailed health insurance coverage limitations and policies are found in the the fine print on the insurance policy. As an example, a lot of people thinking they have adequate coverage, have found out that their health insurance coverage did not even cover a routine or an emergency or necessary medical procedure. This occurs simply because they did not receive the required “Authorization Code” from their provider, prior to the medical procedure, or the hospital did not bother to correctly fill out the required paperwork.
The medical claim you submit to your health insurer can be denied because the hospital personnel happened to used unrecognized “odd codes” for your particular treatment. While any claims that are denied by your health insurance company can be disputed, the process is extremely tedious, time consuming and frustrating, especially if you are in recovery or are ill. There is shockingly very little success in winning these disputed claims as well, which makes this option rather limiting.
Another health insurance coverage limitation occurs more often than most people realize. Imagine that you are say… diagnosed with a specific medical condition and need a corrective operation. You research the various surgeons and hospitals that are allowed within your health insurance plan. You think that you understand your health plan’s coverage regarding hospital care. You then choose the hospital and go ahead and have the required operation, and then you find there is a massive medical bill in your mailbox, you wonder Why the additional billing?
Well, apparently your health insurance coverage did not cover the anesthesiologist or the other medical specialists that the doctors may have consulted for your operation. Thus, you have to pay for these specialists yourself, for the service that they provided, even though you thought that your health plan would cover these costs that were associated with the surgery. Such bills can often be in the thousands of dollars, and there is very little that you can do to dispute the charges. The only way to avoid the charges is to make sure that you find out and ask before you have the operation, who will be involved or consulted and make sure that they are covered in your health insurance plan before proceeding.
Some other limitations that are placed on your particular health insurance plan can include the number of allowable treatments. For example, you may require physical therapy, such as the use of a chiropractor or even visits to a psychiatrist. Many of the health insurance plans will usually put a limit to the number of visits for such medical treatment. Without you realizing it, you may surpass the maximum allowable number of visits allowed by your health insurance plan and end up racking up huge bills.
A lot of people are under the assumption and think that when buying health insurance, they will be fully covered medically, but this is obviously only correct to a point. When securing health insurance, you should read through the fine details of your health insurance package carefully, and then again, if and when you are about to undergo any type of expensive medical procedure. In these cases make sure to consult your health insurance plan first.