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Health Insurance Frequently Asked Questions

Have any questions regarding health insurance? Give Cosmo Insurance Agency a call. Our brokers are masters of the industry and will answer any questions you have regarding health insurance at no obligation.

As of now, Cosmo has put together this list of frequently asked questions:

What rights do I have if my insurance company denies coverage for a service?
You have the right to ask your plan to reconsider its decision. If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether or not to uphold or overturn the plan’s decision. This final check is often referred to as an external review.

If you’re not satisfied with the way your insurance company addresses your appeal or if you need help, every state has an insurance department you can contact about your coverage.

What are out-of-network services and do I have any coverage for them?
Out-of-network services are services provided by a doctor, hospital or other provider that does not have a contractual relationship with your health plan. Not all plans cover out-of-network services, but when they do, your share of the cost is usually significantly higher. For example, an HMO plan may not provide any coverage for out-of-network services, except in an emergency. When possible, try to learn whether the doctor or hospital you are visiting is in-network before receiving services.

What is “balance billing”?
Some states allow health care providers to charge you the difference between what the insurance company has paid and what the provider charges if you seek services from a provider that isn’t part of your plan’s network or doesn’t have a contractual agreement with your health plan. This is called “balance billing” and YOU are responsible for paying this amount.

It’s very important to ask your provider, whether they participate in your health plan, especially if you’re visiting a doctor, specialist or lab for the first time. Participating and preferred providers have agreed to accept your health plan’s payment, called the allowed amount, as payment in full and they have agreed not to bill you for the balance of the charge. This is an important benefit of using providers in your health plan’s network.

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