Searching for health insurance can be a time consuming task. There are some common terms associated with all of it that you need to be familiar with. This will allow you to make the most sense out of the information you read. In order to be able to really compare premiums and benefits you need to have a solid understanding of what they are talking about.
A benefit is anything you get in regards to the health insurance coverage. It can be money that is paid out to you or on your behalf for medical bills. A claim is what must be submitted to the insurance company in order for them to pay a benefit. Sometimes the medical office will submit the claim for you and other times you must do it. Make sure you are aware of how it works in regards to your particular policy.
The amount of money that the insurance agency will pay out though is going to depend on a variety of factors. You may have a co-pay to cover for all of your medical visits. This is a specific amount of money you must pay each time to go to an appointment or pick up a prescription. The insurance company won’t pay that amount of the total bill for you.
It is common for a deductible to apply as well. This is the amount of money you will need to pay before the health insurance company is going to pay anything. In many instances it is a set dollar amount such as $500 per calendar year per household member. In other instances it is a percentage of the total bill. Make sure you know how these terms apply to the health insurance policy you are considering.
HIPPA refers to your privacy when it is related to your health. Under these government guidelines medical offices and pharmacies are very limited with what information they can share without your consent. It also means that if you want someone else to be able to discuss your medical information with them you must sign a written release.
You may find under a given health insurance policy that you have to remain within a given network. This is the group of medical professionals that have agreed to accept payment from such insurance company. They have negotiated what the fees they will charge are going to be. If you seek services from a provider that isn’t in the network you will likely find your claim is denied, or billed without discount.
Should you need to seek the medical assistance of a professional outside of the network you will need to request it in advance. You can have your provider that is in the network submit a referral to the insurance company. If they approve it then you can see that specialist and they will pay for it even though they don’t belong to the network. If the request is denied though you will be responsible to pay for the cost of seeing that specialist on your own.
Learning these basis health insurance terms is very important if you want to make wise choices. Keep them handy as a quick reference with all of your health insurance materials as well. That way you can easily get answers to any of your questions that come along relating to it.