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Understanding and Using Your Health Insurance Policy


When you first get your own health insurance policy, you may be confused at what is your responsibility and how to handle the bills. Many people think they just go to the doctor and pay the co-payment and that is all you need to worry about. But you are responsible for all costs not covered by your insurance company. Health insurance can make your medical costs more affordable.

1. How Does Insurance Work?

Once you buy your insurance policy you will use it when you go to the doctor. The insurance company will have a list of approved doctors who have agreed to charge reduced rates to people who have that type of insurance. The insurance company will then pay the portion of the bill stated in your policy ad you will be responsible for either a co-payment or the remainder of the bill. The book explaining how your insurance works should contain a chart that lists what you pay where.


2. How Do I Use My Health Insurance When I Visit the Doctor?

When you go to the doctor you will need to pay the co-payment. Some insurance policies require you to meet an annual deductible before they will begin covering doctor’s visits, while others do not count office visits towards the deductible amount. Any lab work you receive may fall under the con-insurance amount. For example if you are required to have blood drawn you may be responsible for paying a portion of that bill in addition to the co-payment you paid the doctor. You will need to carefully read the policy before you go.


3. How Does My Health Insurance Work at the Hospital?

When you go to the emergency room you will need to pay the co-payment for an emergency room visit, and the visit will work the same as a doctor’s visit. However, if you are checked into the hospital or if you have out patient surgery or tests done the visit will be treated differently. These procedures operate under the co-insurance part of your insurance. First you will be responsible for the deductible amount if you have not yet met your deductible. After you have paid that the insurance will pick up their co-insurance amount, which is typically eighty percent. You will be responsible for the remaining twenty percent of the visit. However your insurance has worked out lower payment agreements with in-network hospitals, so you should wait until your insurance had paid their portion of the bill to pay the hospital or doctors for the procedures.


4. How Do I Get Doctor Referrals Required by My Health Insurance Company?

Some insurance companies require a referral for you to see a specialist. It is not difficult to get a referral, all you need to do is call your doctor or make an appointment and request a referral from the doctor. The referral form needs to be submitted to the specialist you want to visit and they usually submit the referral to your insurance company before your appointment. You need to be sure that the referral is approved before you visit the doctor, because you can have the claim denied if you do not follow the procedure. Any surgeries or procedures will need prior approval, as well. This may include major tests such as MRIs and CT scans. You should always verify that a procedure has been approved yourself before you have it done, and not rely on the doctor’s office to do it.


5. Can I Claim Medical Expenses on My Taxes?

You can claim any out-of-pocket medical expenses on your taxes each year. File the receipts and pull them out when you do your taxes. You do need to itemize in order to claim the costs. If you have a particularly expensive medical year or if you have purchased a home than you will likely itemize since your deductions will be greater than the standard deduction amount.


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