Health Insurance Articles

How Ambulatory Care Is Covered By A Health Insurance Policy

2011-08-31

As you shop for the perfect health insurance policy, it's important to clearly understand all definitions so that you know your coverage levels. Some insurance policies will provide you with full coverage as long as you pay a co-pay, while others will have you meet a deductible. Ambulatory care is covered by almost all health insurance policies, but you need to know what that includes.

Any outpatient service that includes being seen, tested, treated and diagnosed will fall under ambulatory care. This can be from a family doctor, a pediatrician, a cardiologist, a speech therapist or just about any medical care provider. These services don't require hospitalization, and they will be covered by your health insurance policy, as long as you follow the specific protocols.

If you have an HMO, any services that you require must go through your primary care physician or PCP. After they have seen you and feel that you need a specialist, they will then refer you. Without the referral, you may not be covered if you choose to skip the PCP step.

If you have a PPO, you can go to any of the doctors you want and be covered as long as you pay your co-pay as defined in your health insurance policy. You must also make sure that the doctor or specialist is an "in network" provider, otherwise you may be responsible for all of the charges incurred.

Should you have an HSA or Health Spending Account, you can visit any doctor that you need to and it will be deducted from your total account balance. When that account limit has been reached, you may be responsible for some of the expenses out of pocket too.

Deductibles, if present with your policy, will also need to be met. Ambulatory care is the most common type of care provided because before you can go for any type of ancillary service, such as diagnostics, therapy or custodial care, a doctor must first refer you. It is therefore possible to quickly meet your deductible by utilizing ambulatory care.

You may have specific limits of ambulatory care as defined in your policy per year. If this is the case, you want to make sure you have a very definitive answer so that you don't exceed your limits by accident and be faced with a lot of out-of-pocket expenses. Especially if waiting a few months to have a procedure would have saved you the out-of-pocket expenses, these definitions can help you save your own money. Knowing your health insurance coverage and understanding what the terms mean can make the difference between good care and financial ruin.