How To Tell If A Treatment Is Covered By Your Health Maintenance Organization (HMO) Plan

How can I tell if a treatment is covered by my HMO plan?

HMOs are required to pay for medically necessary care, generally, and they are not required to pay for things they specifically exclude. So the most important part of your health insurance contract is to turn to exclusions and limitations pages, and you'll look in your health insurance contract, and there will a bold setting, exclusions and limitations. Before you do anything else with your health insurance contract, go to the exclusions and limitations, see what they specifically exclude and you can look for generality's. And with something that seems too general, ask them, what are the most frequently denied procedures under your exclusion for experimental, your exclusion for investigative? Ask the broker, ask the sales people these questions. They'll think you are very wise, and at the same time be very guarded in their answers, but it will help get you further down the line, and at least show them that you are a very informed consumer.