New Jersey health insurance

Do you know what health insurance may not cover?

Here’s what so many people forget: New Jersey health insurance from does not cover everything.  Because of that, it’s as important to know what’s not covered as it is to know what is covered. In that way, you will get a fuller picture of the coverage provided and avoid unpleasant surprises. Big bills that must be paid out of your own pocket are to be avoided!

The key thing to remember when evaluating New Jersey health insurance is that you do not want any surprises, especially if you are on a tight budget. That is why it pays to fully understand your policy.

No to nursing home care

Don’t expect  New Jersey health insurance or Medicare coverage for nursing home care unless it is for rehabilitation purposes only, such as after a stroke or hip surgery or some similar procedure. You must have a reasonable chance of regaining functionality for the stay to be covered and even then it would be for a limited amount of time. The insurer wants you back home as soon as possible.

Long term custodial care is not covered under the vast majority of plans.

If you break the law

If you hurt yourself while doing something illegal and seek medical care, you may not get reimbursed. So don’t rob a bank, get shot and file a claim for your hospital stay. It probably will not be paid, even though if you were accidentally shot without the bank robbery, that same stay would be covered. If you need another good reason to be a law abiding citizen, New Jersey health insurance coverage is that reason.

What prior authorization doesn’t mean

You may think you know what prior authorization means, but it probably doesn’t mean what you think it does.  It does not mean the plan will cover a procedure. Most plans say that any benefit is subject to “medical necessity” (they make that determination) you’re your “eligibility.”  You could have the procedure and then have your insurance plan say that it wasn’t necessary, medically, and refuse to pay. There is usually a way to appeal, but be aware that this could happen.

Travel inoculations aren’t covered

If you think you can get that malaria preventive reimbursed, or any travel shots, think again. No travel preventives are included in most policies. You must pay those yourself.