Iowa Health Insurance
If you need a medical procedure, test, or service it’s always a good idea to make sure your Iowa health insurance plan covers it before going ahead with it. This is because there could be some specific things the policy doesn’t offer coverage for. You don’t want to go ahead and get the procedure done and then find out your health plan won’t help you out.
Just about all HMOs (health maintenance organizations) and insurance providers will look over all claims to make sure the procedure, test, or service was deemed as medically necessary. Should the insurance company decide that it wasn’t medically necessary then there’s a very good chance they’ll turn the claim down.
Since your claim more or less needs to be medically necessary it’s a good idea to find out exactly your insurance company regards as medically necessary and it doesn’t. Basically, a medical necessity is a type of health care service pr supply which is used to evaluate or treat a condition, disease, injury, or illness which is considered to be consistent with the applicable standard of care. This also includes evaluating and experimenting with investigational procedures, services, devices, and drugs.
If your health plan requires you to see a PCP (primary care physician) it will be up to him or her to decide what’s medically necessary and what isn’t. However, the insurer and HMO may require that the PCP obtains approval from the plan’s medical director. Some things that aren’t considered to be medically necessary are: inpatient hospitalization for medical treatment which could be performed on an outpatient basis; staying in a hospital after your medical conditions and symptoms have improved and hospital care is no longer required; cosmetic surgery; any type of treatment which is provided to the patient for their convenience, such as choosing a Caesarean section for childbirth; an advanced treatment or procedure that was provided without first attempting less expensive and invasive treatment.
The reasons for not covering medically necessary treatments are obvious since this treatment would see health insurance costs rise even higher. Even if your doctor prescribes a specific procedure or treatment it doesn’t always mean the HMO or insurance company will agree with it. This is why it’s recommended that you seek preauthorization before getting it attended to. Some health policies will require that you ask for preauthorization.
If your Iowa health insurance provider denies your claim by saying it isn’t for a medical necessity you have the right to appeal their decision. If you’d like to be sure just exactly how your current health plan works it’s recommended that you get in touch with the insurance carrier. If you’re in the market for a health plan you can have all of your health insurance questions and inquiries answered by an independent and licensed health insurance agent.
This person will let you know what is and isn’t covered and who you would go about filing an appeal. They’ll also be able to compare a variety of Iowa health insurance plans with you and find one that suits your personal health care needs. This includes both private insurance plans and those offered as public programs by the government.