Benefits and Claim Procedures: Health Coinsurance

Health Coinsurance benefits are a provision under which the insurer and the insured share costs incurred after the co-pays and deductibles are met, according to a specific formula or schedule. You can learn all about how coinsurance works and how it fits with other healthcare insurance policies here.

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Health Insurance Co-Pays, Deductibles and Pre-Certification

There are many qualifications and limitations regarding what health insurance covers and to what extent. A co-pay or co-payment is the contractual amount you must pay for your use of a specific medical service covered by your health insurance policy. Pre-certification is a requirement, but not a guarantee of payment of benefits.

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Health Ins Claims: When Your CSR Isn’t Helping, Should You Take It Straight To The Top?

The process of getting a simple health insurance claim paid can be very frustrating and often leads to bad faith insurance claims. When nobody seems to know what’s going on, you’ve explained your situation over and over again and your customer service representative (CSR) just isn’t helping, should you take your concerns straight to the top of insurance companies such as Aetna, Cigna, Anthem Blue Cross, WellPoint, Humana or Kaiser Permanente?

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Accidental Injury, Ambulances, Office Visits, Tests

Accidental injuries, ambulance transportation, office visits and outpatient lab and diagnostic tests which are included as covered services in your health medical insurance policy are discussed. In many policies, office visits are subject to a co-pay. The expense of doctor visits is applied to your deducible. If you believe that most of your expenses (not that you can ever know for sure) are going to be of the routine nature, you may wish to purchase a policy with a different plan that has a limited co-pay for routine doctors’ visits

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Outpatient Surgery

Other articles in this series cover inpatient hospital confinement benefits by examining typical sample provisions of an individual health insurance policy. This article will examine typical policy wording dealing with health insurance benefits for outpatient surgery.

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Benefits and Claim Procedures: Emergency Room Services

Your policy is likely to have separate pages describing the benefits for Participating Provider Services and Non-Participating Provider Services. As previously explained, participating provider services are subject to a calendar year deductible and non-participating provider services are subject to a Separate Deductible for Non-Participating Providers. Though the deductibles that apply are different, the description of the covered expenses themselves are nearly identical.

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