Common Health Insurance Coverages and Terms

In many accident cases, the victims need immediate help. They often need to go to a local emergency room. They may need to have surgery. The sooner they begin treatments, the sooner they can return to full health or to better health. They usually will need to treat with a general physician, different types of specialists, and therapists. Victims usually need medications to get better.

This means patients normally must inform their doctors and health providers about their own health insurance since there’s no guarantee that an accident case will settle or that there will be a verdict. For this reason, everyone in Oklahoma should understand the basic ways they can obtain health insurance and the various coverage issues.

The different providers of health insurance

There are different types of liability policies depending on whether the accident was a car accident, an accident on someone’s property, an accident due to a product defect, an oilfield accident, or another type of accident. In accident cases, the liability policies of the defendants who caused your injuries should ultimately pay out for your medical expenses and pain and suffering, if you file a claim or win a lawsuit.

Depending on where you work, where you live, your income level, your age, and other factors, insurance is generally available in Oklahoma in the following ways.

• Private insurance. Currently, individuals can obtain private insurance to cover most of their health coverage needs. Many people have private insurance that is paid in whole or in part through their employer. If the employer doesn’t pay for any health coverage, then you must purchase your own health insurance. If the employer pays for part of the coverage, then the worker must pay the balance of the premiums.
• This insurance is generally available to people in Oklahoma if their income level is considered low-income. Medicaid may also be available for seniors, 65 and older, to pay for nursing home care, assisted living, and other similar services.
• This federal program is generally available to people who are 65 years and older. It covers a broad range of services. It pays for about 80% of your core medical bills. The other 20% requires a supplemental insurance policy.
• Medicare Part D. This is the insurance that covers your prescription drug costs. Seniors generally must choose which insurance carrier to use for this coverage.
• Affordable Care Act. This coverage is generally for low to middle income people who have limited income. Individuals can choose from different insurance plans. They may be entitled to a subsidy based on the plan they choose and their income level.

There are different types of insurance providers. A few examples include:

• Exclusive Provider Organizations (EPO). Here, the patient (accident victim) must choose health providers in the plan’s network – unless there’s an emergency.
• Health Maintenance Organization (HMO. “A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO.”
• Point of Service (POS):These plans require referrals from your primary care doctor to see a specialist. Many other rules apply.
• Preferred Provider Organization (PPO):In this plan, you pay less if you use a doctor in the plan’s network though you can treat with health providers outside of the plan – for a higher cost but without the need for a referral.

Disabled workers, children, and others may also qualify for Medicare or Medicaid. There are also health plans that pay only in the event of a catastrophe, or if you become disabled.

Common health insurance terms

There are numerous insurance terms that govern the various insurance policies. A few common terms are:

• The premium. This is the monthly payment that must be paid to the insurance carriers. In some cases, such as for Medicare, the premium is deducted from a senior’s social security check.
• This is the amount an insured individual must pay out of pocket. It’s the amount the insurance coverage doesn’t cover.
• When people see their doctors and health providers, they may be required to pay a portion, such as percentage or a specific dollar amount, for each visit.

Health insurance coverage options are very complex. As a general rule, our Oklahoma City injury lawyers focus on the liability insurance of the defendants and the workers’ compensation insurance for your employer. When necessary we do work to coordinate your health coverage with the liability coverage. For questions about medical coverage in any accident case, call the experienced personal injury lawyers at Cunningham & Mears, Call 405.212.9234 or complete our contact form to schedule an appointment.