Insurance Information

Insurances in which CEC participates

• AARP Medicare Supplement

• Aetna

• Aetna Innovation Health PPO

• Aetna Medicare Advantage

• Aetna Senior Supplement

• APWU

• Anthem MediBlue Plus

• Anthem PPO

• Bankers Life

• BlueCross BlueShield

• CareFirst

• CareFirst Administrators

• CareFirst BCBS Federal

• Cigna International

• Cigna Open Access

• Compass Rose

• GEHA

• GPM Life Supplement

• Humana

• Humana Medicare Advantage

• PHCS Multiplan

• Physicians Mutual

• Mail Handlers

• Medicare

• Medicare for Railroad Workers

• Meritain

• Mutual of Omaha

• NALC

• SAMBA

• Thrivent Financial

• Transamerica

• Tricare

• UnitedHealthcare Choice Plus

• UnitedHealthcare MDIPA

• UnitedHealthcare Medicare Advantage PPO

• USA Senior Network

• USAA Life

• UMR

Understanding Your Insurance Coverage

Your insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called “covered services.”

Your policy also lists the services that are not covered by your insurance company. You have to pay for any “uncovered” medical care that you receive. Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.

There are many different insurance plans. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.

• Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them; this is called “prior authorization” or “pre-authorization”.

• Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.

• Remember that your physician, not your insurance company, makes medical decisions and recommendations about what will benefit your health status. If your insurance does not cover a recommendation by your doctor, you can still obtain treatment, but you may have to pay for it out-of-pocket.

• If you have questions about your coverage, call your insurance company and ask a representative to explain it.
  
  

Most services your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment or get a prescription filled for a drug that isn’t covered, your insurance carrier will “deny the claim.” If this occurs, CEC will appeal the denial on your behalf and provide treatment and testing results to support the appeal. However, your insurance carrier may uphold their decision of denial. Should this occur, payment for that service, treatment, or prescription becomes your responsibility.

You still have the right to continue to appeal (challenge) the decision in an attempt to secure reimbursement from your insurance carrier.

Adapted from: American Academy of Family Physicians, 2001