Health Insurance

Caribou

Caribou

September 10, 2020

Your health insurance policy states which treatments and services are and aren’t covered. When you step foot in a doctor’s office for the first time, they typically ask for your policy details to keep on file. That way, they can bill the insurance company for the costs associated with your visit. 

After the visit, you’ll receive an Explanation of Benefits from your insurance company that states which parts of your medical care were and were not covered. The medical bill will follow, which will outline how much you owe for that specific visit. 

Common Types of Health Insurance Plans

It is important to understand the types of health insurance that you have so that you are aware of all the costs associated with your treatments.An Health Maintenance Organization (HMO) plan is popular. It includes access to specific doctors and hospitals within a defined network for a monthly or annual fee. People typically choose an HMO plan if they are price sensitive, as it often has low premiums and deductibles, and fixed co-payments.

Preferred Provider Organization (PPO) type of plan allows you to tap into a network of health professionals and centers at reduced rates for a subscription fee. PPO might be an option for you if you utilize health care services and specialists regularly, want the flexibility of going out-of-network without obtaining referrals, and would like to pay more for premiums but less for the actual health care services. 

HDHP (High Deductible Health Plan) may be an option for you if you are healthy and don’t expect to use many health care services within the next year, as with this type of plan, you’ll have a higher deductible and lower monthly premium. However, be sure that you can afford the out-of-pocket maximum in a worse case scenario.

Steps to Appeal a Denied Insurance Claim

Denied insurance claims are very common. More often than not, people believe that there is nothing that can be done, when in fact, you can be successful in appealing a denied insurance claim by following a few simple steps.

First, check the claim for any errors like a misspelled name or the wrong date of birth. If everything seems accurate, read over your insurance policy to verify that you should in fact be receiving coverage for this service or treatment. If you see it listed in your insurance policy, call your insurance company to state that your policy should be covered (be sure to speak confidently!). 

If you aren’t successful with that, then it is time to write an appeal letter. 

Extended Coverage Through Through COBRA

If you have left your job recently, it is likely that you are wondering about your options for health insurance. COBRA insurance (coming from the Consolidated Omnibus Budget Reconciliation Act) lets you keep the same health plan from your job for 18 months or longer after leaving. There are certain eligibility criteria that apply, but it’s likely that you can access this coverage if you worked for a private-sector organization with greater than 20 employees.

This option is often the easiest when compared to finding a new health insurance plan through the marketplace, as you don’t have to worry about switching doctors or transferring files. Your plan remains the same as it was while you were employed, but you will now be paying the full monthly premiums so the cost will be higher than what you were used to.