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The inception of the Affordable Care Act, otherwise known as the ACA, means more Americans have access to health insurance and emergency care coverage than ever before. Unfortunately, understanding your benefits can be complex. Whether your insurance is provided through an employer, through the ACA Marketplace, or through another source, understanding your benefits can be complex. What's more, no one wants to worry about what services are covered, should you ever need access to emergency care. Visits to the hospital can be expensive, and while no one in need of medical assistance can be turned away, it's important to understand your benefits to be prepared for any resulting costs. Here are some important questions to ask your health plan administrator. Is there a copayment or deductible? It's common for insurance companies to require you to pay either a copayment or deductible for emergency care services. A copayment is a flat fee per visit, which is usually higher for trips to the ER. A deductible is the minimum amount you need to pay before insurance coverage begins. Be sure to know these amounts for your particular plan. Do I need prior authorization to make sure my visit is covered? Different health plans have different rules, so be sure to know know yours. Some plans require a 24-hour notification of going to the ER, while others might require your primary care doctor to authorize your treatment, particularly if the condition isn't "life threatening." Insurance companies will give you a list of what they consider to be "life threatening," so be sure to familiarize yourself with it and recognize that something like a broken leg or injured wrist likely won't meet their requirements. Do I need to use a specific hospital? Some plans have "in network" hospitals, and will only guarantee insurance coverage at those facilities. Be aware that you will incur additional costs if you go to a hospital outside your network. How are medical necessities determined? In an emergency care situation your treatment won't ever be delayed. However, once your condition is stabilized, doctors and hospital staff will work with your health plan on what treatments to do next. In some cases, the health plan can override the doctor's recommendations. Be aware if this is a stipulation in your plan. Can I do anything if my health plan refuses my emergency care claim? The best initial course of action is to file an appeal with your insurance provider. If at first you don't succeed, continuing to ask might yield positive results. Different people at the insurance company will review your appeal each time, so you may eventually have success. If that still doesn't work, you can reach out to your state health department and file an official complaint that will trigger an investigation. Provided your claim is legitimate and you've followed your providers' rules, that should resolve any issues. To learn more about emergency care, Saginaw, MI residents should visit http://www.stmarysofmichigan.org/services/featured_services/emergency_care/index.php.
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