What Does Health Insurance Cover?

Health insurance policyholders need to be informed and well aware of the legal ins and outs regarding their policies. However, there are many people out there who are not as aware of the proceedings as they should be, and a sudden illness or serious accident is not the best time to start discovering what your policy does and does not cover. Unfortunately, when such catastrophes occur, that is typically the only time that many policyholders have any concern regarding their coverage. It is vital that they learn just what their policies will cover before tragedy strikes.

Will Health Insurance Cover Emergency Services?

While most typical health insurance policies do take care of emergency medical services, it is important to be aware of what a policy’s basic deductible is. That basic deductible usually starts at around $50, but it is important to double check with the policy to be certain. However, it is important to understand that a health insurance policy only pays for visits that are considered actual emergencies, so for a common cold or minor ache, it is best stay home and get some rest. Unless there is a real accident or medical emergency, such as a dangerously high fever, the emergency room is not necessary.

Will Health Insurance Cover Routine Services?

Most annual routine check-ups, such as a physical or a pap smear, are covered by health insurance, but only a certain amount of each service will be paid for, usually once or twice per year. The deductibles on some of these policies can be sky high – well into the thousands, in some cases.  As a result, anyone who must visit a doctor several times per year needs to find a comprehensive insurance policy with low deductibles. Other services may also be covered, like vision, in which case one visit per year to an optometrist is covered by most health insurance policies.

Will Health Insurance Cover Diagnostics and Surgeries?

Minus the deductible, of course, surgeries and diagnostic services within reason are taken care of by most health policies. These may include X-rays, CAT scans, and similar diagnostic procedures. However, before taking a special test, it is a good idea to check with the insurance company to make sure you will be covered, since surgeries are typically paid for with pre-authorization from the insurance company. The answer may take anywhere from a day to a month to obtain, but once received, the patient can see a general break down of what the visit will cost them.

The Main Benefits

While most health insurance companies do provide most of the financial assistance needed for medical services, it should be noted that they rarely pay 100 percent of the bills. An average patient should expect to pay 10 to 50 percent of their bills out of pocket. In order to get the best possible coverage, it is a good idea to find out beforehand what you need out of a health insurance policy, and purchase coverage accordingly. By taking good care of yourself and having good coverage, the general need to rack up bills with doctor visits can be lessened.