Know Your Health Insurance Policy

Fact: Due to the ever-increasing costs associated with the healthcare industry, doctors and hospitals have a greater risk of not collecting their payments once the patient has left the facility. Therefore, it is becoming more common for doctors and hospitals to request copayments and/or deductibles at the time of service.

2. The hospital or doctor's office has to accept whatever my insurance pays as payment in full.

Fact: Get very familiar with your policy. According to the agreement you made with your insurance company, you agreed to pay a premium every month and they agreed to pay your medical bills. In most cases you also agreed to pay a deductible, copayment and/or coinsurance. It is your responsibility to know the terms of your insurance policy including covered benefits and restrictions. If you choose to have a procedure that your insurance does not cover, you may be responsible for all charges.

3. I can go to any hospital or doctor's office I want and my insurance will cover it.

Fact: You can go to any hospital or doctor's office you want, however, depending on your policy you may have a network hospitals and doctors. If you visit a hospital that your insurance company considers in-network, your benefits will be much better than if you go to a hospital that is out-of-network. Most insurance companies out-of-network benefits tend to pay less while the consumer pays more.

4. If I need therapy, I can go as long as I want and my insurance will cover it.

Fact: Most insurance policies have a maximum amount of days they will cover for therapy visits. If you or your doctor feel as though you may need additional days you may request additional days from your insurance company, however, you may have to pay for your visits in full until a decision has been rendered.

5. It doesn't matter if I have a pre-existing condition, my insurance will cover it.

Fact: A pre-existing condition is a condition that you had and were informed of prior to obtaining health insurance. Most insurance companies will pay for treatment unless you had a lapse in coverage for over 60 days. In that case, you may have a waiting period of 6 months to a year before they will cover any pre-existing conditions.