What To Do When Your Health Insurance Doesn’t Pay For A Medical Service

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If you encounter any medical situation but only to your surprise, the insurance won’t pay off. This is a difficult situation for anyone who is unable to afford the bills otherwise. Therefore, before getting any health insurance, you should read the contract carefully. Furthermore, make sure that the policy covers a wide and necessary range of medical situations. Because there won’t be any use of your policy if you are unable to get timely treatment.

Thus, you should always take the first step carefully. Ask some doctor or medical expert about the things that should be in an insurance policy. Afterward, ask your agent what services he is offering. In this way, you will be able to secure a proper deal.

However, you should also know that there are still certain sections that are not covered by health insurance. Irrespective of the type that you choose, insurances won’t pay for all of your claims.

What can you do?

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So when you encounter any such situation where you are unable to get any help from your policy, you can go to kemberton.net. It is a network of professionals that offer personalized advocacy for complex coverage. Their aim is to help you when covering medical expenses is complex.

Of course, this does not mean that they will pay for your bills. Instead, they will try their best to get you that maximum from your policy. Furthermore, they will also let you know about the other subsidies that you can avail of. Likewise, they have a team of healthcare experts who will let you know if there is any leniency for you. You can either change the treatment to get it under your policy or can get financial aid.

Learn about your policy

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So when you come across the statement that the insurance policy won’t pay for the medical expenses, the first thing you should do is to contact some expert. It would be better if you can go through the policy by yourself, if not, a lawyer would be your best choice.

Go through the policy and check whether there is any misunderstanding. It is highly likely that the agent is trying his best to not pay for the bills. Therefore, if there is any possibility of this thing, you can know it from the policy. After all, everything is mentioned there. So whether your medical condition comes under the policy coverage or not, you will know it.

What does health insurance cover?

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Except for a few, usually, most of the health insurance policies covers a visit to doctors and hospitals. It also covers your prescription drugs, your medical devices (if any) and also your wellness care. Therefore, whether you have a mild fever or you are in need of an IV drip, you won’t have to pay for these from your pocket. Your health insurance will cover all the bills.

What the policy won’t cover?

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Except for the exceptions, insurance policies do not cover cosmetic procedures. These cosmetic procedures include plastic surgeries for getting double eyelids, jawline or anything else.

Apart from cosmetic surgeries, usually, health insurance also does not cover dental bills for complex treatment. For example, if you need to get your tooth removal, the policy might cover it. Likewise, it might also cover the visit to a dentist. However, getting braces or teeth alignment does not come under it.

In addition to this, insurance companies won’t also pay for;

  1. Fertility treatments
  2. Private nursing
  3. Long-term care
  4. Weight loss treatment

Likewise, getting treatment through highly expensive and brand-new technologies also comes under a luxury. Therefore, the insurance company won’t pay for it. And also, if you use off-label drugs, the company also won’t pay for it. So you should get treatment by talking to your doctor.

In this way, the hospital or the doctor can guide you properly so that you can get proper treatment.

What if the company denies paying for a certain treatment?

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If you have a doubt that the treatment might come under your policy, you have the right to appeal. The first step is to talk to your agent, if he does not respond positively, you have other ways. Go to the company yourself and talk with them. If the agent is playing a game with you, you will know once you talk with the company directly.

However, if things do not go your way, you still have the option to appeal your claim. There is an act known as the Affordable Care Act that is for people like you. It helps you to appeal against claim denials. So if the company is not paying for your medical bills, you can make an appeal against them.

If your claim is legitimate and treatment is necessary, there might be a way. It is also possible that you get any medical aid or subsidy. Or you might have to pay only 30 percent yourself. Any such help will be beneficial for you. So make sure you get it.

Look for a medical billing advocate

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If your medical bills are too much and you are unable to afford it and the policy is also of no help, you can hire a medical billing advocate. There are certain hospitals and doctors that charge you too much. Furthermore, they also suggest unnecessary treatments and procedures only to get more from your pocket.

Therefore, if you are suffering from any such situation, your advocate can reduce your bills. In this way, he can also make the insurance company pay off your bills. Even if they do not cover them, you might be able to afford the bills.

You might not know this but a lot of medical practitioners charge you more. A lot of medical bills have errors. Therefore, through careful dealings, you can get rid of such errors. If the treatment was avoidable, your advocate might make the hospital responsible for the treatment.