Planning Ahead: Tips for Pre-Approval and Knowing How to Get The Most Out of Your Health Coverage

When it comes to health coverage in the insurance industry, many clients worry about what will/will not be covered when it comes to an emergency, such as an unexpected ER visit, a health scare, unplanned surgery, etc. While these are at the forefront of people’s minds when they think about their health insurance and what it means for their family, the reality is, emergencies are not the norm, and it’s much more likely that you’ll end up using your health coverage for routine care and planned procedures. While these things can be covered by your insurance, it’s important to know that plans vary greatly from provider to provider, and also have varying levels of coverage based upon different plans. Your premium, deductible, out-of-pocket max, etc. are important to understand when you’re facing healthcare needs, and pre-approval is a big part of having peace of mind with your health insurance.

Pre-approval is pretty self-explanatory, in that it means getting prior approval by your insurance company for any upcoming healthcare, therapies, surgeries, hospital stays, etc. By contacting your insurance provider and working with them before the care is administered, you won’t end up with unexpected bills for things you thought would be covered. Common circumstances that prompt clients to seek pre-approval are:

• upcoming (medically required) surgeries recommended by a physician
• medically required therapy(ies)
• maternity coverage (OB care, delivery and related hospital stay, sonograms, etc.)
• visits to a specialist (often following referral by a patient’s physician)

Pre-approval for these circumstances is important since it not only makes sure you’re financially prepared for any resulting charges that may come your way, but also to make sure you’re seeing a provider within your network if this applies to your plan. Many insurance providers require that you use specific doctors, specialist, surgeons, hospitals, etc. in order for them to provide the highest level of coverage, so being pre-approved and having the reassurance that your chosen doctors or hospitals will work with your insurance company.

Carroll Marshall Insurance serves our clients with insurance advisement that not only helps you find the best coverage for your family’s needs, but we also offer continuing support to make sure you understand the process of pre-approval, filing paperwork for approval or for reimbursement when applicable, finding providers within your network, and anything else to make sure you feel empowered in your insurance coverage and confident that you will be ready for what life throws your way. We are ready and waiting to help you, so give us a call or stop by our downtown Winter Haven office.