Frequently Asked Questions About Health Insurance

FAQ Health Insurance in San Diego, CA

Purchasing and using a new insurance plan can be a confusing endeavor. This is especially true now that more Americans are finding it necessary to bind supplementary policies to expand their basic coverage. Following are answers to a few common questions about health insurance, brought to you by the insurance experts at Tri-Star Insurance.

Do I Need to Contact My Insurer Before Receiving Emergency Treatment?

Many consumers are worried about racking up excessive emergency room bills as the result of treatments that have not been preapproved or otherwise authorized by their health insurance in San Diego. It is important to note insurers cannot require consumers to get preapproval for this essential care. Thus, if you have an illness or an injury that needs attention right away, you don’t have to worry about paying any additional fees for failing to report this visit in advance.

Can Copayments or Coinsurance Increase Due to an Emergency Room Visit?

Policyholders cannot be charged additional money in copayments or coinsurance when visiting the emergency room. Charging policyholders these extra monies is illegal. The policyholder’s copayment and coinsurance must remain the same for these and all other visits.

What Happens If My New Insurance Plan Doesn’t Cover My Old Doctor?

If a preferred doctor is no longer in your network, odds are you won’t be able to continue using his or her services under this same policy. For prior visits and treatments that were received before any notification of a network change, however, policyholders can use the appeals process. Any decision to not pay for these past visits can be reviewed by an independent third party for possible revision.

How Do I Appeal an Insurance Agency Decision?

The appeals process for insurer decisions typically involves a review performed by an independent third party. Anytime your insurer makes any significant decision, you must receive notification of this decision in writing along with information on how you can submit a formal appeal. In addition to the standard appeals process, policyholders should also be given details on filing expedited appeals for all insurer decisions that might have an immediate impact on their wellbeing.

If you have further questions regarding health insurance, reach out to American Tri-Star at 619-272-2100. In addition to health insurance, we also offer a wide variety of other insurance services. For free quotes on affordable car, homeowners, commercial, and bond insurance San Diego residents trust, give us a call and one of our friendly representatives would be happy to assist you.