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Will I Be Covered For My Medical Procedure?

It is important to realize that although you might consider your medical insurance

organization your own this certainly does not mean that they are on your side. As a matter of fact, medical health insurance is big business and as a result your health care insurance company has only one thing in mind and that is making money.

A lot of people do not truly understand this until they really hit a serious illness or are in need of an operation or some other form of emergency care and it is usually at this point that they will see their health insurance coverage company refusing to pay for an assortment of different and necessary things and the light bulb truly comes on. You see the more they have to pay out the less money they have so it is ultimately the goal to pay out as little money as possible which is why so many different things get denied for an assortment of different reasons.

Many insurance companies use catch phrases and clauses to get you to break specific rules which will give them an excuse to deny your claim and among the most common ways that health care insurance companies tend to do this is by using a pre-authorization clause when it comes to emergency treatments. Counting on the fact that you are going to be too harried and will be in crisis in the heat of the moment the insurance company then wants you to call them and request approval for treatment prior to going to the hospital anytime that you are conscious.

So think about the scenario your child falls from their tree house and breaks their arm. You immediately tend to their needs and rush them to the hospital but forget to contact your health insurance company to request pre-authorization. The hospital may perhaps catch this and contact them for you but if they do not the insurance company now has the option to deny any claims that stemmed from this unauthorized treatment.


It seems like such a simple thing to do but most people will not do it very simply because they either wont realize that they supposed to or they will be so caught up in the situation that they will very simply forget to follow through with contacting the insurance company prior to entering the hospital emergency room. Gaining a clear understanding of the ways in which your health insurance company is wanting to make money will better aid you in taking full advantage of the benefits that you do have. Following all the rules is the best way to get more of your claims paid and less of them denied.

by: Ethan Kalvin
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