Society & Lifestyle

Why health insurance doesn’t cover non-standard charges

One common aspect that health insurance often does not cover is non-standard charges. Health insurance is important as it provides financial protection and access to medical healthcare for individuals and families. However, it’s necessary to understand the health policy limitations and exclusions in health insurance. Let’s understand the reasons behind this limitation and focus on what non-standard charges are and how they can impact your healthcare expenses.

Why health insurance doesn't cover non-standard charges

Understanding non-standard expenses

Non-standard healthcare costs, also known as out-of-network charges or balance billing, refer to the fees charged by healthcare providers who are not in your insurance plan’s network. When you receive medical services from an out-of-network provider, they may bill you for the difference between their charges and what your insurance plan covers.

Network providers and coverage

Typically, health insurance plans have a network of healthcare providers with whom they have negotiated discounted rates. These network providers have agreed to accept the insurance plan’s payment as full payment for covered services. You are responsible for paying only the co-payments, deductibles or co-insurance specified in your policy when you receive medical care from an in-network provider.

Reasons why health insurance doesn’t cover non-standard charges

  • Contractual agreements: Contracts are negotiated with specific healthcare providers to establish a network. These contracts outline the rates that the providers will be paid for covered services.
  • Cost control: Networks are created to control healthcare costs and provide affordable coverage to policyholders. By negotiating discounted rates with in-network providers, they can better manage expenses and keep premiums affordable.
  • Provider choice: Health insurance plans encourage policyholders to seek care from network providers to ensure quality and coordinated care.

Impact on Healthcare Expenses:

You may be responsible for a significant portion of the medical charges when you receive care from an out-of-network provider. Here’s how non-standard charges can impact your healthcare expenses:

  • Higher out-of-pocket costs: Non-standard charges often result in higher out-of-pocket expenses that may only cover a portion of the out-of-network provider’s fees.
  • Balance billing: In some cases, out-of-network providers may bill you for the full amount of their charges, which can be significantly higher than what your insurance plan deems as reasonable and customary. This practice is known as balance billing and can lead to unexpected and significant medical bills.
  • Financial burden: Especially for individuals who require specialised care or live in areas with limited in-network providers, non-standard charges can create a financial burden.

Tips to minimise non-standard charges

  • Understand your network: Verify if the provider you intend to visit is in-network to ensure maximum coverage before receiving care.
  • Seek pre-authorization: Obtain pre-authorization for elective or non-emergency procedures. This process helps determine whether the procedure will be covered and whether any non-standard charges may apply.
  • Inquire about network adequacy: If you live in an area with limited network providers, contact Kotak General Insurance to inquire about network adequacy. They can guide you on how to access necessary care while minimizing non-standard charges.

Conclusion

While health insurance provides essential financial safety for medical treatment, it often doesn’t cover non-standard charges. Understanding the reasons behind this limitation and taking proactive steps to stay within your insurance plan’s network can help minimise the impact of non-standard charges on your healthcare expenses.