Health Insurance: Understanding What It Covers

Applying for medical insurance provides you with an assurance that your insurance company would pay for your medical bill if time arises.  However, many health insurance policy holders have forgotten to read the finer details of their contract, with some end up feeling the brunt of paying their medical care at full price.  This does not mean we are discouraging you from taking medical insurance, but we do recommend reading these helpful tips to understand what your medical insurance covers.

What does a medical insurance cover?

Your health insurance policy lists a package of medical benefits that your health insurance company would cover the cost.  These are called "covered services," which include tests, prescription drugs, and treatment service needed in various diseases. 

However, the extent of covered services differs from one insurance company to another, and some medical conditions are not covered at all.  HIV infection, for instance, is not covered in some insurance policies.

What if my doctor recommends services that are not included in my policy?

These services that are not covered by your insurance policy remain uncovered most of the time.  This means that your insurance claim is denied and would have to pay the whole cost yourself.  However, there could be tests and treatments that are covered by your policy that your doctor is not aware about. 

You need to understand your insurance policy, taking time to read it (including the fine print), and inform your doctor about what your health insurance plan covers.  If you are having trouble with some details of your policy, contact your insurance company and ask a representative to explain it.

Can I contest my insurance company’s denial of claim?

If your insurance company refuses to cover your medical tests, prescriptive drugs, and treatment, you have the right to appeal the decision.  However, you need to know how your insurance company does its appeal process.  Also, ask your doctor if it is right to make an appeal.