What are the basics of health insurance coverage?

Health insurance contracts are frequently group insurance contracts wherein you, as a member of a group, pay a premium to the insurance company in return for the insurance company agreeing to cover medical and hospital expenses up to certain limits. The general limitation of the scope of coverage under these policies is that the treatment that you receive must be reasonable and nec­essary and the cost of the treatment must be consistent with the usual and customary charges for other practitioners in the area.

For instance, if you decide to have plastic surgery that is pure­ly elective, this type of treatment may not be covered unless you have a specific endorsement or provision within your policy that provides coverage since the treatment is not necessary. Likewise, if you choose to go to the most expensive orthopedic surgeon in the area because you think he or she is the best, all of the charges rendered by that surgeon may not be covered under your policy. The policy is governed by what is usual and customary for those types of services and not necessarily by what the best practitioner in that area may charge.

Because of the complexity of health insurance policies, you may not have a clear understanding of what is covered and to what extent it is covered. This can be a real problem when most need the insurance and assume that you will be covered.

Ask an Attorney

Feel free to ask a legal questions that you would like answered. Your question will go directly and only to Deskin Law Firm, a professional law corporation. Deskin Law Firm will contact you directly to discuss your situation, usually via telephone, so please provide multiple ways to reach you via phone. Your situation will be kept confidential. There is no cost to discuss your situation and no attorney-client relationship is created by simply filling out the form and sending it.

Please type your first and last name.

Please type your area code and phone number.

To most effectively be able to reach you, please type another phone number where we may be able to reach you.

Please type the city and state (and country if outside the USA) that you live in.

Please type your email address and check it to make sure it is correct.

This question is for testing whether you are a human visitor and to prevent automated spam submissions.
1 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.