Medical insurance as a term normally always refers to what is commonly known as a health insurance policy or a health insurance plan. It is important to distinguish these wordings, as sometimes medical insurance could literally refer to some type of errors and omissions policy for a hospital/doctor or other healthcare provider.
This type of insurance does exist widely, but generally speaking when people refer to medical insurance they are referring to what is commonly known as health insurance or health care insurance. Medical insurance that is referring to health insurance has a number of general principles that are important to understand.
Whilst this type of insurance conforms to all the standard principles of most types of domestic insurance, it is much more tightly regulated and specified in terms of cost and benefit than other types of insurance. In addition an insurance company will have a much tighter control over the range of benefits and who may or may not provide them.
The basic idea behind a medical insurance/health insurance policy is that the policyholder will pay an insurance premium to the insurance company who will agree to provide a range of financial benefits that are intended to pay the cost of a medical intervention, possibly a stay in a hospital and other associated costs. Where the insurance company takes a very tight control is in two underlying concepts that really define the notion of health insurance. The first is what the insurance companies refer to as prior authorisation.
This means that if the policyholder wants to have any type of medical intervention or diagnosis or treatment that would be covered under the terms of the insurance policy, then the policyholder must get the agreement of the company to go ahead with such treatment prior to it taking place.
If the policyholder does not get prior authorisation in this sense, then the insurance company will pretty much automatically decline to pay any claim.
The other term that company will use is that of the diagnosis or treatment being deemed to be 'medically necessary' with the company themselves making that decision as to whether the treatment is medically necessary or not.
This in effect means that any type of medical intervention or treatment that a policyholder wishes to pursue must be agreed beforehand by the insurance company, and the insurance company makes the final decision as to whether such treatment is necessary or not, not the policyholder or their physician or other healthcare provider.
This often gives rise to many problems, and should be fully explored by a policyholder before any medical insurance/health insurance plan or policy is taken out or renewed.
Peter Main is freelance writer who writes extensively about health, healthcare and health insurance with a particular focus on current issues and debates, such as the state of healthcare reform and how it impacts on peoples lives.
Article Source: http://EzineArticles.com/?expert=Peter_Main
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