Don't confuse Health Insurance with Health Care. Though some insurers include health care in their name and advertising, they simply do not provide any care. And you should not expect them to. It's a marketing tool at best and disingenuous at worst.
Doctors and hospitals and other providers render care. Insurance companies pay for the care on behalf of their insured clients. Why should you really believe anything else?
A great guide to the history of health insurance was written by Melissa Thomasson of Miami University. She details the development of the health insurance markets going back to the beginning of the 20th century.
All insurance, including health insurance, is nothing more than a contract. In general terms, the contract states that the insurer will reimburse the policyholder for eligible claims under the contract as long as the policyholder pays their annual premiums. Most contracts cover the period of one year. Pretty simple.
The health insurance contract states not only what will be paid and how, but what will NOT be paid. It's the NOT paid part that causes the most trouble and angst among health care providers and insured clients. But it is the most important part.
What the insurance company states it will NOT pay, listed clearly in the contract, is called the Exclusions. Exclusions are important to deflect fraud and misuse of the insurance resulting in paid claims being higher than they would otherwise be. If not for exclusions, your health insurance premiums would no doubt be astronomically higher.
Often times, doctors and patients decry the insurance company as not allowing a procedure, surgery or other prescribed care. This is not necessarily so! Rather, the insurance company will not reimburse the insured client for a procedure, surgery or other prescribed care not under the contract previously agreed to by the insured. Read your insurance contract - most importantly, before you buy the coverage!
Be assertive. Ask questions. Ask them of your doctor. Ask them of your insurance agent before you buy the policy!
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