When you have a chronic illness, or a condition that requires frequent medical attention, you may find yourself making recurring trips to the hospital.

These visits can quickly become expensive, so it’s important to understand what is covered by your insurance plan. Here’s what you need to know:.

Understand Your Health Insurance Plan

The first step to understanding your hospital coverage is to review your health insurance plan. Different plans have different levels of coverage, so it’s important to know what you’re covered for before you need medical care.

One important factor to consider is whether your plan has a deductible. A deductible is the amount of money you are responsible for paying before your insurance kicks in.

If you have a high deductible plan, you may need to pay for a certain amount of hospital visits out-of-pocket before your insurance starts covering the costs.

Another important factor to consider is whether your plan has a co-pay or coinsurance. A co-pay is a set amount of money you pay for a medical service, while coinsurance is a percentage of the cost of the service that you are responsible for paying.

For hospital visits, your co-pay or coinsurance may vary depending on the type of care you receive and whether the hospital is in or out-of-network.

Check Your Network

Before you schedule any hospital visits, it’s important to check whether the hospital is in your insurance network.

If the hospital is out-of-network, you may need to pay higher out-of-pocket costs, or your insurance may not cover the costs at all.

Additionally, some insurance plans may require pre-authorization for hospital visits. This means that you need to get approval from your insurance company before you can receive certain medical services.

If you don’t get pre-authorization, you may be responsible for paying the entire cost of the visit.

Understand Your Coverage for Different Types of Hospital Visits

Not all hospital visits are created equal. Depending on the type of care you need, your insurance coverage may vary. Here are a few common types of hospital visits and what you can expect your insurance coverage to be:.

Emergency Room Visits

If you have a medical emergency and need to go to the emergency room, your insurance should cover the costs of your visit. However, you may need to pay a higher co-pay or coinsurance if you go to an out-of-network hospital.

Inpatient Hospital Visits

If you need to stay in the hospital for an extended period of time, your insurance coverage may vary depending on the type of room you stay in.

For example, if you stay in a private room, your out-of-pocket costs may be higher than if you stay in a semi-private room.

Outpatient Hospital Visits

If you go to the hospital for a medical procedure or test, but don’t need to stay overnight, this is considered an outpatient visit.

Your insurance coverage may vary depending on whether the hospital is in or out-of-network, and whether the procedure or test is considered medically necessary.

Understand Your Prescription Drug Coverage

When you’re making frequent trips to the hospital, you may also need to fill multiple prescriptions. It’s important to understand what is covered by your prescription drug coverage.

Some plans may require you to use generic drugs instead of brand-name drugs, or may have a limit on the number of prescriptions you can fill in a certain period of time.

Appealing Denied Claims

If your insurance company denies coverage for a hospital visit, you have the right to appeal the decision. You can start by contacting your insurance company to explain your situation and request that they reconsider their decision.

If this doesn’t resolve the issue, you can file an official appeal.

Keep in mind that the appeals process can be lengthy, so it’s important to start as soon as possible. You may also want to consider working with a healthcare advocate or a lawyer who specializes in insurance issues.

Conclusion

Recurring hospital visits can be stressful and expensive, but understanding your insurance coverage can help you avoid surprises and make informed decisions about your healthcare.

Be sure to review your health insurance plan, check your network, and understand your coverage for different types of hospital visits and prescription drugs. And if your insurance denies a claim, don’t be afraid to appeal the decision.