So many times I hear clients tell me how disappointed they were that the claim they put into their Medical Insurance company was denied. Medical Insurance carriers go to a lot of trouble making sure their members understand the coverage of their Medical Insurance policy.  A ten day free look is offered with every Medical Insurance policy.  Most clients rely heavily on what their Medical Insurance agent has told them about the policy.  Usually the client knows what the deductible is what the doctor co-pays are and sometimes they remember what the Medical Insurance stop loss is for their policy.  Once they get the policy it usually gets filed and they never look at it again.

Until they go to the hospital, or have surgery or maybe some outpatient testing.  Since they have not read the policy they probably did not notice that there are some general exclusions and limitations.  These items are not riders to the Medical Insurance policy but are conditions that come with almost every Medical Insurance policy.  One set of exclusions that is universal to all Medical Insurance carriers reads something like this: Expenses incurred by a covered person for treatment of tonsils, adenoids, middle ear disorders, hemorrhoids, hernia, or any disorders of the reproductive organs ( except cancer) are not covered during the covered person’s first six months of coverage under the Medical Insurance policy.  This provision will not apply if treatment is provided on an “emergency” basis.

What exactly does that mean?  Let’s say that your son Tim is complaining of a roaring sound in his ear and dizziness.  It seems to just come and go and may not bother him for weeks at a time.  Just after you get your Medical Insurance policy Tim begins to complain of pressure and pain in his ear.  Of course it’s at night (when else do these things happen?). You get concerned and take him to the Emergency Room.

The doctors think Tim might have Meniere’s disease.  Now, here’s the complicated part.  If the doctors decide to operate because they are afraid Tim may lose his hearing in that ear that would fulfill the “emergency” basis clause above.  If they do not operate, then the trip to the ER, if it was in the first 6 months of the effective date of the policy, would not be covered by the Medical Insurance carrier.

Medical insurance brokers are compensated by the Medical Insurance carriers.  You will pay the same premium if you use a broker or not.  Medical Insurance brokers usually represent several different Medical Insurance carriers.  A Medical Insurance broker will know the best Medical Insurance company for you and make sure you get the best bang for your buck.  Shopping around for Health Insurance Quotes?  Start first with a licensed Medical Insurance broker.

Medical Insurance

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