Can anyone explain to me how health insurance works?
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Asked October 3, 2011
Your health insurance policy works differently according to the issuing company and any options you have taken on the policy. In general, no health insurance policy covers everything, and even the things that are covered may not be covered completely. Before you receive a surprise bill in the mail, review your policy and make sure you know what is provided and what is expected of you. If you have questions after reading your policy, contact your health insurance agent or your company's Human Resources department.
Dental procedures are not typically included in health insurance policies, but most plans have optional coverage that you can purchase at a slightly higher premium cost. Even when dental is included, be sure you understand what is covered, because some plans only pay for routine cleaning or checkups, but do not pay for dental surgery, or only pay a specified percentage of the cost.
Similarly, vision may be covered by your policy, but only up to a certain point. You may only be allowed to see an ophthalmologist a certain number of times, or the insurance may only pay a limited amount for each procedure.
There are also multiple types of health insurance plans, and each one has a different set of rules and requirements. For instance, a PPO will let you see a doctor who is not a member of the health insurance network if you agree to pay the difference in cost, but an HMO will not pay any portion of the bill if you see a provider not in their network. It is important that you understand what your policy covers and how you can make the best use of the coverage. Do not be afraid to ask your insurance provider to explain anything that you are having a problem understanding.
Answered October 3, 2011 by Anonymous