What Kinds of Hospital Outpatient Expenses are Covered?

Coverage for outpatient services generally include laboratory tests, medicines, consultation, CT scans, physical therapy, MRI scans, ambulance services, mental health assessments and consultations. Other services that don’t require in-house treatment are also billable to the insurance carrier. For example, when the insured visits the emergency room for a consultation but not necessarily an admission, it is part of the insurance coverage. All types of policies will cover this, whether your plan is a standard one offering partial coverage or a special one that offers full coverage.

Paperwork will be part of the reimbursement process. Normally, an individual needs to settle the bill first, then, request to be compensated by the insurance provider after all the necessary documents have been processed and approved. Essentials like official receipts from the services availed of by the patient and laboratory tests or scan results must be kept in file. If the insured goes on doctor’s orders then signed prescriptions must be handed to the insurance company for verification. This must have the original prescription from the doctor and prescription for the procedure or exam to be undergone by the patient or the medication that needs to be administered.

Try to request for these important documents while availing of medical services. It would be more difficult to go back and request for them afterward. Ensure that all the reports and information, to be passed to the insurance carrier, are in English. This makes the reimbursement process faster for many insured parties. Consider that when insurance providers need to hire other firms to translate documents, the process only takes longer. In addition, keep a duplicate, if possible, or photocopy of the original documents that will be handed to your insurance company. These companies handle hundreds, even thousands, of requests daily and there is a chance of your file to be misplaced. By keeping your own file, you can assist the insurance company in expediting the processes despite some paperwork being lost.

Even when covered, many individuals refuse to submit their reimbursement claims stating that they already have “high deductibles”. No matter how small the amount may seem, getting reimbursed would add to the value of the deductible. This is a good way of being prepared and practical. Every penny counts when one gets admitted for medical reasons. Plus, no one knows when this can happen.

Read the insurance policy. Most, if not all, insurance carriers do not reimburse for “wellness checks”. This implies that, procedures like mammograms and executive check-ups that include general physical examinations might or might not be covered by your insurance carrier.

When it comes to outpatient surgery, always check with your insurance provider before going through any procedure. Over the years, medical developments have allowed for less invasive and faster operations. Surgery for the removal of cataracts can now be done as an outpatient procedure. Today, an admission need not be required for a colonoscopy as well. It’s important to determine the extent of coverage ahead of time.