No matter the type of health care insurance coverage you have, it is important that you review your policy provisions. If you don’t have a copy of your policy, you can either review the provisions online or request a new copy. Your policy will explain the terms of coverage, define policy language, outline coverage and exclusions. If there is anything that you do not understand, you can contact the plan administrator’s customer service department and they will help you decipher that which you may not grasp.

Reviewing your coverage is important as it may help to prevent expensive surprises in the future. Your policy will explain how you qualify for payment of benefits. It may state that the care must be “medically necessary”; the definition of medically necessary care may differ from policy to policy. An elective procedure may not be deemed medically necessary and your insurance provider may deny your claim. Your policy will also explain who is eligible for coverage under your plan; a dependent as defined by your health insurance policy, may not meet your conventional definition of dependent.

It is important to also review what procedures are covered or excluded. A routine, preventative mammogram may be covered with no out of pocket expense for you. However, a diagnostic mammogram, performed when a mass or lump has been found, may be subject to a copay or coinsurance amount. Your plan may provide coverage for medically necessary weight reduction surgery. But, it may not cover any cosmetic surgery to remove excess skin that occurs as a result of the rapid loss of weight. Spending some time reviewing your health insurance coverage may help you to avoid unexpected, additional health care costs.