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To learn more about the health care reform law, check out:
A key to understanding your health plan -- and avoiding surprises when the bill comes -- is knowing what your payment obligations are, including:
It's wise to keep track of your deductible status, especially if your deductible is high. If you meet the deductible amount in a given calendar year, think about getting other costly procedures or treatments done within the same year rather than waiting until the next year when you have to meet your deductible all over again.
Your Rights If You Have a Dispute
If you disagree with a decision or action by your health plan -- a denial of coverage, refusal to authorize treatment by a specialist, or any other adverse action -- you may have the right to a review of that decision. Most states and most health plans allow a plan participant to ask for an internal review -- that is, you make a formal request to have the health plan reconsider a decision related to your coverage. (To learn more about the internal review process for health plan disputes, You may also have the right to an external review (an appeal that's heard by an organization or panel that is not affiliated with the health plan).
Review is often limited to certain types of health plan disputes. Be sure to know the time limits within which you must file for review as well as any forms and documents you must submit. (To learn more about your right to an internal or external review of a health plan's negative decision,
To learn about managing health care expenses and dealing with other pressing financial issues, get The Busy Family's Guide to Money, by John Waggoner, Kathy Chu, and Sandra Block (Nolo with USA Today).
by: Kathleen Michon, Attorney
Health Insurance Plan Details < Previous Page
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Once you determine the basic type of plan, it's time to delve into the details. You need to understand what is covered, what procedures must be followed, how payment works, and your appeal rights if you have a dispute.
The best place to get this information is from the insurance policy itself. Carefully read the Summary Plan Description. In addition, read the Evidence of Coverage -- this is the detailed description of the plan (not just the summary) that lays everything out. If you have purchased your own insurance policy, the company will have already provided you with this document. If you have an employer-sponsored plan, ask your employer for a copy. The Evidence of Coverage may be available online as well.
Read your policy to find out what services, treatments, and procedures are covered. Even more important, take note of what is not covered. Excluded services might include infertility treatments, acupuncture, cosmetic treatments, treatment of obesity, mental health care, nursing home care, and substance abuse treatment. Here's a look at some common coverage limitations:
Many health plans require the consumer to follow certain steps in order to get coverage for services. If you don't follow the health plan's requirements to a "T," you can be sure it will deny coverage. Here are some things to look out for: