Category: Understanding My Benefits

Insurance101

What does my health insurance cover?
Understanding how medical policy and your benefits work.

It’s simple.
At its core, health insurance is really quite simple. It covers the cost of medical care and protects you from the high cost of illness or injury. Like auto or home insurance, it provides peace of mind.

It’s different.
Health insurance differs from other types of insurance in many important ways. For example, if you are involved in an accident, you expect your auto insurance to cover the cost of the repair. You don’t expect your auto insurance to cover everyday expenses like oil changes, gas or general repairs.

It’s complex.
Yet, Americans have come to expect health insurance to cover everything from major illnesses to everyday medical expenses. If this was the case, the cost of health insurance would be far greater than it already is.

It’s important.
That’s why medical policy is so important. Life-saving medicines and state-of-the-art technologies and procedures are constantly evolving. Some can dramatically improve health. Others are experimental. Some are proven to be more effective than others. All of them add to the cost of health care, and consequently, the cost of health insurance.

It’s our job.
At Blue Cross and Blue Shield of Kansas, our role is to protect our members from the high cost of health care, while keeping the overall cost of our members’ health insurance in check. The more we pay out in health insurance claims, the higher costs are passed down to our members in the form of premiums.

Medical policy and how it impacts member benefits is perhaps the most important part of our job. Here, you can learn more about how we make medical policy decisions, the role of medical necessity, and your rights as a member.

Understanding My Benefits

How we make medical policy and member benefit decisions

Increasing the quality of care while containing costs When health insurance picks up most of the cost of medical care, there is a perception that “someone else” is paying. But really, it’s your money. When you, your family, and your co-workers use more and more medical services, the cost is passed on in the form of higher premiums, copayments, coinsurance, and deductibles. That’s why medical … Continue reading How we make medical policy and member benefit decisions

Blue Cross and Blue Shield of Kansas4 Comments
Understanding My Benefits

What’s the difference between medical necessity and a covered benefit?

Why a doctor-prescribed service or device isn’t always covered by health insurance Medical necessity and covered benefits are two entirely different things. A medical necessity is something that your doctor has decided is necessary. A covered benefit is something that your health plan or policy has agreed to cover. The fact that a doctor may prescribe, order, recommend, or approve a service does not always … Continue reading What’s the difference between medical necessity and a covered benefit?

Blue Cross and Blue Shield of Kansas4 Comments
Understanding My Benefits

What are my rights as a member?

When it comes to your health plan, knowledge is power As a Blue Cross and Blue Shield of Kansas member, you are entitled to certain rights and responsibilities. Some are guaranteed by federal law, such as the right to get a copy of your medical records, and the right to keep them private. The health care law also offers rights and protections that make coverage fairer … Continue reading What are my rights as a member?

Blue Cross and Blue Shield of Kansas2 Comments