Colorado CO Health Insurance
Reader’s Question:
What do you mean by policy waivers and exclusions for a health insurance policy in Colorado? Are there any other things in the smaller print that I need to know?
Candice
Aurora, CO
Hello there, Candice!
Most health insurance companies in Colorado develop policies with certain exclusions which are termed as “waivers and exclusions”. These are really statements that the health insurance company will not pay for certain types of accidents or sicknesses. Once you sign a waiver, it now becomes part of the policy. Waivers are put together for the company to exclude a specific illness you have or a previous injury in the past and waivers can be permanent. Waivers can only come off a policy of you and the company agree too remove such waiver.
I will also take this opportunity to inject additional information on most HMO and PPO plans. Most are required to provide a way for you to appeal coverage benefit decisions which you believe are wrong, such as when you think that your claim is incorrectly denied or if you are not treated fairly. The state law requires that health insurance companies should have a plan to administer a process in case of grievances or disputes. That way, health insurance policy holders will have a quick and inexpensive way to resolve disputes. Also, it retains your right to the health insurance company if needed.
Another important concept is that there are some companies that require you to submit a pre-certification of any healthcare service or procedure that you undertake for your to get reimbursed by the health insurance company.
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