It is frustrating to try to hunt down good health insurance Georgia plans. But don’t give up. There are many licensed, independent insurance brokers out there that could help you narrow down your health insurance Georgia plan options if you are starting to feel overwhelmed.
What if you do have a health insurance Georgia policy both through your own place of employment, and then as part of your spouse’s health insurance Georgia plan. Which health insurance Georgia policy should be used first for the children? When that happens, there is a complicated protocol for which health insurance Georgia plan to use for medical benefits first. Adult persons use their own health insurance Georgia policy first. If there is a remaining balance, they can then submit the claim to the other health insurance Georgia policy to see if there are benefits that can be paid on that policy. For the children, there is what is called “the birthday rule.” This means that the health insurance Georgia policy of the parent with the birth date that falls earlier in the year is primary, and the parent with the later birth date is secondary. So claims for medical services for children would be claimed on the health insurance Georgia policy of a parent with a birthday in January, for example, rather than the policy of the parent with an August birthday. This process is called coordination of benefits, and it refers to when there are two health insurance Georgia policies in effect for the same person.
Health Insurance Georgia Policy Complicated Issues
Another complicated aspect of health insurance Georgia plans are prior authorizations. Prior authorizations are necessary for certain medical procedures or services. Each policy has its own requirements of when prior authorization is necessary. Often, it is required of hospital visits, mental health services, or other outpatient treatment. It is the member’s responsibility to know when their health insurance Georgia policy requires prior authorization and to obtain it. The member will have to call the 800- phone number on the back of their health insurance Georgia ID card, and the customer service representative will probably give them a code. The member should then take this code to the doctor or facility when it is time for the medical service to occur. Without prior authorization, a health insurance Georgia carrier may reduce the benefits paid out, so this step is very important.
A final complicated term for health insurance Georgia policies is usual and customary charges. This refers to the amount that a health insurance company determines is a fair and typical charge. This is what they decide to accept as a fair charge. If your physician or hospital, or provider charges more than that, the health insurance Georgia carrier will not pay the full amount. If you are seeing a provider that is a part of the health insurance Georgia plan network, then that provider agrees to accept the fee the insurance company negotiated with them, and they will not charge you the difference in the billed and agreed upon amount. However, if you are seeing an out of network benefit, then the insurance will pay their portion of what they consider a usual and customary charge, and whatever the balance is will be your responsibility. In fact, staying inside the health insurance Georgia plan network is a protection from this sort of situation.
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