How can you double-check the treatment you need is covered by yourhealth insurance?
Know your insurance policy, understand your options, and talk with your healthcare provider.
But that’s not always the case.
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Healthcare providers view your condition from a medical perspective, not from an insurance standpoint.
Patients, though, have more alternativesand more successesin negotiating health care costs and benefits than they may realize.
Under the new rules, health plans cannot exclude pre-existing conditions or apply pre-existing condition waiting periods.
All plansincluding grandfathered plansare banned from applying lifetime benefit maximums on essential health benefits.
However, no policy covers everything.
Insurers still rejectprior authorizationrequests and claims still get denied.
In other words, covered does not necessarily mean that your health plan will pay the bill.
But sometimes, a doctor recommends a service that isnt covered, which can be challenging for the patient.
Centers for Medicare and Medicaid Services.Affordable Care Act implementation FAQsset 15.
Centers for Medicare and Medicaid Services.Frequently asked questions on essential health benefits bulletin.
New York State Department of Financial Services.Surprise medical bills and emergency services.
Department of Health and Human Services.Appealing health plan decisions.
Centers for Medicare & Medicaid Services.Affordable Care Act implementation FAQsset 15.
University of Florida Health.Affordable Care Actclinical trial coverage.
