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5 Things Your Health Insurance Company Won't Tell You

Wednesday, 06 Oct 2010 09:17 AM

Today, having medical health insurance is imperative. With skyrocketing health care costs, it pays to have an adequate health insurance plan. Here are five things that health insurance companies won’t tell you. However, by being proactive at the time of purchase, one can avoid unpleasant surprises in times of need.

1. All hospitalization is not covered
While most health insurance companies list hospitalization details in health insurance plans, they put the details in fine print. Even if the doctor recommends hospitalization, it may not be covered, either because the particular hospital is not among the health insurance providers or because the cause of hospitalization is not covered or a host of other reasons. Therefore, before purchasing health insurance plans, understand the hospitalization details and what portion of each category cost will be covered by the health insurance provider.

2. What is not covered (but is very important)
Certain types of diseases are not covered by some health insurance companies. These include diseases they later claim relate to pre-existing conditions. This type of denial of a claim negates the purpose of medical health insurance. Even top health insurance companies resort to such tricks when processing claims. Therefore, find out what diseases are not covered by the health insurance provider. Clarify with health insurance providers what they consider pre-existing conditions at the time of plan purchase. In some family health insurance or spousal insurance policies, certain treatments for the spouse may not be covered.

3. Copayment or hospitalization charges can be avoided with a slight increase in premium
Most health insurance companies have a copayment system in place to avoid excessive usage of health insurance privileges. However, when it comes to hospitalization, these copayments and a percentage or hospitalization charges become payable. These can add up to huge amounts. Therefore, when buying health insurance plans, check if a small addition in premium can reduce your copayment liability portion. Sometimes, only a couple of dollars extra can drastically reduce your copayment amount.

4. Fine print not explained
The fine print of medical health insurance plans of even top health insurance companies contains information that is important. However, it is often ignored by customers. These details talk about workers compensation coverage overlap and auto insurance coverage overlap. What portion of injury is work-related or auto-accident related, or related to regular wear and tear can be a debatable issue. There are instances when valid claims are denied by health insurance providers by shifting the onus onto the auto insurance company or employer. These situations must be spelled out at the time of purchasing medical health insurance from health insurance companies.

5. Spouse not covered
There are several health insurance companies that advise customers to add their spouse for a premium increase of a few dollars more. What they do not reveal is that the spouse does not get all the coverage you may opt for. Check what is not covered for your spouse. There are instances when even the wife’s maternity claim is not covered by certain top health insurance companies.

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