Get The Most... After You're Insured
Her are a few suggestions on how to get the most from your insurance policy, if needed.
1. Be Aware Of The "Pre-Certification" Clause In Your Insurance Contract.
Nearly all temporary health insurance policies contain a "Pre-Certification" or "Pre-Notification" clause. Simply put, this says that you must notify the insurance company prior to hospitalization or other large anticipated medical claims. Failure to do so could reduce your coverage dramatically, so we emphasize that you and all family members be aware of this provision.
Pre-Certification enables the insurance company to be sure that you are receive adequate and appropriate care, to pre-negotiate fees and charges, and to arrange for payment.
When using a Short-Term or Intermediate-Term insurance plan, it is your responsibility to contact the insurance company for Pre-Certification, or to ensure that your doctor or other medical provider contacts the insurance company on your behalf. Failure to "pre-certify" with the insurance company usually results in a severe reduction of benefits. A simple rule of thumb: if in doubt, contact your insurance company.
Exception - a medical emergency: In a medical emergency, seek treatment immediately. Then you or a representative should contact the insurance company ASAP or within 48 hours. Consult your insurance policy for details.
2. Take A Moment To Review Your Policy.
Quality health insurance coverage is never cheap. You owe it to yourself to take a few moments review your coverage, its requirements for use, limitations, etc. Be sure you understand how best to use your coverage if needed (such as "Pre-Certification").
3. Hospital Emergency Room Visits.
Hospital emergency facilities are often convenient and especially so after normal business hours. But typically, your health insurance will not pay for expenses incurred during a hospital emergency room visit which is not of an emergency nature.
*In a medical emergency, seek immediate treatment at the nearest appropriate facility.
Here is a general definition of a medical emergency: a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing a person’s life or limb in danger, if medical attention is not provided within 24 hours. (Usually, symptoms are sudden and unexpected.)
