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SpinDistribute.com Article Directory

The following article was published in our article directory on April 14, 2012.
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Facts about Health Insurance

Article Category: Finances

Author Name: Neil Primack

Health insurance has two kinds and these are government and private insurance. Government offers Tricare, Medicare and Medicaid insurance. Tricare is for active military members and their families. Medicare is for people 65 years old and above. Medicaid depends on one's annual income. All of these are administered by the federal government. Private insurance is administered by companies which the government is not a part of. The eligibility for this type of insurance differs and is almost always offered via an employer.

In choosing a health insurance plan, you should first know the participating providers. All insurance programs have a network of medical providers such as doctors, specialists, hospitals, home health agencies, nursing homes and other institutions that are allowed to give medical care. All insurance programs have a recipient enrolled to get medical attention and the insurance companies give them the list of their provider services.

To get an insurance plan, you should inquire about payment requirements. There are companies that necessitate payment called "co-pay" from a beneficiary for the kind of medical care they want. The company shall require a larger deductible for this. Both private and government insurance may ask for this. You should therefore know if the insurance plan has services such as hospital stays and physician visits.

When you want to avail of the services in your health insurance plan, you should find the provider in the network and make an appointment with that provider. The provider's receptionist will then get basic information from you before you schedule your visit. You may also be required to give the ID number your insurance company has given you.

Ask from the insurance company the coverage of their plans. When you arrive at your appointment, the receptionist will inquire about your insurance card. She will then contact the insurance company to verify your eligibility and the kind of services you are eligible for.

After the verifying the services you qualify for, you will then meet with the provider who will assess your health needs. He would then advise you to see specialists when necessary. The insurance company may require you to ask from your provider to give a referral for the specialist.

The provider's billing representative will then submit to the health insurance company a claim. This contains a description of your health situation, basic demographic and the procedures performed. This can be a standard form that is required by the company. This is either air-mailed or emailed to the company for payment.

The claim to be paid will take a month to two months. Follow-up of this is usually done by the manager of the provider's office if the payment has not been received during the specified time. It would not be your job to follow-up the payment nor to explain to the provider the late payment.

The next step would be for the insurance company to send to you an explanation of benefits where you will be informed of the payments made to the provider and any remaining balance that you need to pay.

These are the basic facts you need to know about health insurance.

Keywords: Health Insurance, Medicare Supplemental Insurance, Medigap Insurance, Group Health Insurance

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