It seems like such a simple and straightforward question about Pennsylvania health insurance or any health insurance plan, doesn’t it? But you may get answers that surprise you. That’s why you should ask them upfront, before you sign on the dotted line.


If you expect that all medical procedures your doctor says that you need will be covered by your private Pennsylvania health insurance, think again.  That means even life-saving surgeries, like an organ transplant, or common procedures, such as kidney dialysis may not be reimbursable.  You may end up opening your own wallet to pay for these pricey medical services.


Every health insurance plan is different

You may expect to be refused coverage for psychotherapy, acupuncture or infertility treatment. But it may be a big surprise that your routine gynecological visit and ambulance service are not covered.  Some plans refuse to cover diabetes case management, while others believe this helps keep more serious diabetes claims to a minimum. Every plan is different.


If you are of childbearing age you may want to make sure your plan covers maternity and well baby care. Check to see if your Pennsylvania health insurance covers physical therapy.


If you think you’re safe because your doctor and hospital are in network, you need to dig further. What about other specialists that might see you during a procedure? Are they in network? If they are not, you may be faced with a hefty bill for their services.


It’s important to understand that with Pennsylvania health insurance—and health insurance in any state—no plan covers everything. Some procedures will always be on the not reimbursed list. Make sure you know what they are.


Neither Medicare nor Pennsylvania health insurance cover nursing home care. You may find coverage for a rehabilitation stay in a nursing home, but only if you have some reasonable chance of regaining functionality. Long-term custodial care is rarely covered.


You can appeal to your health insurance plan

You wan to learn as much as you can about your Pennsylvania health insurance plan so that you are prepared for any eventuality. And if all else fails: appeal. Many customers find that if they stick to their guns, they get a positive result from their appeal. It’s not a guarantee, but it is an avenue you can try.


Remember to get as much as you can in writing. Any exceptions or approvals must be given to you in writing for them to have any standing.