By Carlos Diez
When purchasing health insurance one has to be carefully prudent regarding expectations on payable benefits. There are a multitude of websites online on the internet that are fabricated to represent spectacular coverage while simultaneously being elusive about displaying terms or conditions as well as exclusions and limitations. Not reading the fine print can leave you stuck with the bill and out hundreds or even thousand of dollars.
In this article we will assume that the general reader reading this text has no preexisting conditions. If preexisting conditions are present we encourage the reader to review other articles previously written by us, as they expand on the subject in greater depth and detail.
What To Look Out For.
(1) Expenses incurred by a covered person for the treatment of tonsils, adenoids, middle ear disorders, hemorrhoids, hernia or any other disorders of the reproductive organs and will not be covered during the covered persons first six months of coverage under the policy certificate.
The key word to this exclusion is “reproductive “and is very applicable to males as well as females attempting to visit a general practitioner or obstetrician for a check up during the initial first few months of their benefit period. This is probably one of the most common exclusions on most policies and is responsible for most claim denials for females between the ages of 18 – 35 according to Ingenix, a United Health Care company that aggregates claim expenditure data.
(2) For charges related to or in preparation for tissue or organ transplantation.
Most of us obtain major medical health insurance in order to protect ourselves and family for unforeseen catastrophic losses. This exclusion is implicit in an abundance of policies sold in the individual private healthcare market and is responsible for most of the lawsuits circulating within industry today.
(3) The contract holder or member may be terminated with prior written notice by the insurer if contracted deductible or coinsurance amounts are not satisfied within 30 calendar days from the data of service where healthcare services were obtained.
There are a lot of proponents sharing a consensus or deductive reasoning that in the state of this economy one could achieve affordable health insurance on a typical managed care preferred provider organization by simply raising your deductible. Before following and ensuing the advice ask about this provision. Paying for healthcare premiums only to have a termination letter on a otherwise non-cancelable policy for failure to meet this requirement is more than a slap in the face, chances are now you are dropped off the plan without being covered and are considered to have a pre-existing condition as well.
What To Do.
If you are discussing a healthcare policy with a licensed insurance agent in person or over the phone ask about terms and conditions. Concentration on benefits and price is sometimes irrelevant if the general limitations and exclusions stipulated within the policy certificate is not beneficial to you.
About the Author: Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers.
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