Health Insurance and What Procedures It Usually Covers

    EL SEGUNDO, CA, July 21, 2011 /24-7PressRelease/ -- Despite the fact that health insurance costs have increased an average of 12 percent a year for the past several years, making securing this coverage increasingly difficult for employers and employees alike, many people don't have a clear sense of what important surgeries and procedures their insurance does or would cover, so they are less equipped than they should be to make crucial decisions about their insurance coverage. This same information is also somewhat useful for small care providers that may have to fill out medical claim forms and need to understand what is covered and how to get paid.

The first concept to understand about health insurance is that procedures that aren't medically necessary are typically not covered, but this rule is applied with a reasonable degree of fairness in most cases. So while breast augmentation surgery will not be covered, nose reconstruction surgery necessary to restore comfortable breathing after a major accident probably will be, while corrective laser eye surgery is a grey area and it depends on the specific details as well as the policies of the insurance provider. The second principle is that as insurance companies compete to come up with affordable policies that capture peoples' shrinking insurance budgets, every provider will have small differences in what they will cover, how much they'll pay, and the deductable and co-pay levels, for example.

This brings up the point that more than anything the best tool to make the right insurance decisions is a willingness to ask insurance providers persistent, specific, and direct questions about their coverage. They know their rules but may not be forthcoming about the fine-print exceptions that could leave you paying out of pocket. It is fairly easy to determine the basics of a health insurance plan in this way, and then decide which one, if any, is the best financial decision. The difficulty comes in trying to anticipate future needs and to identify what current health characteristics may lead to higher health care costs in the future, which the health insurance company won't want to pay for. So more than anything, research is essential.

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