Health Insurance Lawyers
Types of Health Insurance Plans
There are a number of different health insurance plans available to you. Usually your employer will have a group health insurance plan that you can participate in. You can also buy health insurance on your own.
Here are the three most common types of health insurance plans available:
- Fee-for-Service - If you have fee-for-service health insurance then you must pay a monthly fee called a "premium." As you see doctors over the course of a year you will be responsible to pay a specific amount called a "deductible." Usually the deductible is around $250-$1000 per year, but it can be more or less. Once you have paid the deductible, your insurance company will start paying a percentage of your medical bills; you will pay the remaining percentage. For example, your insurance company might pay 75% of your medical bills, meaning you would pay 25%.
- The major benefit of having a fee-for-service plan is that you can choose to see any doctor you want to and change doctors whenever you wish.
- Health Maintenance Organizations (HMOs) - HMO companies take care of all your medical needs including doctor's visits, prescription drugs, and hospital stays. When you sign up for an HMO plan you pay a monthly fee. Then, when you need to see a doctor or have to go the hospital you only pay a small co-payment, usually around $5 to $25. There is no deductible for an HMO plan.
- Unfortunately, HMO's usually do not let you choose your own doctor. You are either assigned to a primary doctor or given a limited choice of doctors. You cannot see a specialist or another doctor without a referral from your primary doctor.
- Preferred Provider Organizations (PPO) - Preferred Provider Organizations (PPOs) are like HMOs in that you pay a monthly fee, which entitles you to see a limited number of doctors for a small co-payment. A PPO, however, does not completely deny coverage when you see a doctor who is not a member of the PPO.
- When you see a doctor outside of the PPO, your insurance will pay a percentage of the bill. You will have to pay for the remaining part of the bill.
My Health Insurance Company Denied Payment for Medical Treatment. What Should I Do?
The first thing you should do is review your health insurance policy. The policy will tell you whether or not your health insurance company was supposed to pay for the medical treatment you received.
If you think you were entitled to coverage and your insurance company denied it, you should file a complaint with your health insurance company. Most insurance companies have a complaint process that you can go through to try and get payment for your medical treatment. If this fails, and you still believe you deserve payment, you may want to file a lawsuit against your health insurance company for bad faith.
Do I Need an Attorney to Help Me with My Health Insurance Problem?
Interpreting your health plan policy can be tricky. An attorney can help you understand your policy and let you know exactly what kind of benefits you are entitled to. If you have a problem with your health insurance company and want to sue them, an attorney will know the process of taking on a big health insurance company.
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Last Modified: 11-14-2011 04:16 PM PST
