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Understanding Health Insurance Coverage And What It Means To You


In a contract like the individual health insurance, there is a need for a person to understand what he is paying for. Knowing what he pays for means he can take advantage of these services with no hesitation when the time comes. And in the contract like the individual health insurance where there will be an agreement between two parties, the contract will contain of a listing of the medical benefits and services.

Some of the services and benefits that will be itemized in the health insurance include medical tests, drugs and other treatment services. If on the said health insurance plan the insurance provider agrees to cover the cost of these benefits, then these are called covered services in the industry.

Whatever services are listed in the contract and signed by the health insurance provider then these form part of the health insurance coverage. Learn to know what are covered in health insurance and what are not The plan does not only list the covered services that form part of the health insurance coverage; the insurance that a person gets will also list the many medical tests and services that will not be covered by the insurance provider.

What this means is that the person who is under this kind of individual health insurance plan will have to pay for these medical services and treatments. Understanding the health insurance coverage means getting the differences between medical necessity and the covered service in the medical insurance. The medical benefit in the person’s medical insurance is the thing that the health insurance provider is willing to pay for as part of the contract.

The medical necessity of the individual health insurance on the other hand is something that the doctor of the individual may prescribe and there will be times that this necessity may not be part of the health insurance coverage. In the typical contract the health insurance coverage will determine what kind of tests, drugs and services will be covered by the health insurance plan provider. Since there is that possibility that the doctor may prescribe medications and treatments that are not part of the medical insurance, then it is suggested that the person should work hand in hand with the doctor.

It is important that the doctor should be familiar with the person’s health insurance plan so that the doctor can provide a treatment that is covered. What to do if some services are not covered in the health insurance? With this in mind, the person should have a better understanding of the insurance coverage and this can be done by taking time to read the health insurance plan, and questions about the insurance should be forwarded to the provider fast. It is also important for the person to be ready just in case the doctor prescribes something that is not covered by the health insurance plan.

When that happens then what the person get is called in the industry as ‘denying the claim’. This may happen and the person will have to pay for that treatment or services. If the medical insurance provider denies the claim, then the person can still appeal and challenge the decision.

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About Author
Articles Stats
  Published Date - February 2 2009
  Total Views - 598
  Total Votes - 2
  Average Rating - 2
  Comments - 0
  Mr. Ace Parker
Ace Parker tackles health insurance and its complexities. For more information on health insurance plans visit
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