when a company in the U.S. pays for medical benefits, does that usually only include doctor visits?

Question

What happens if you broke your arm or had cancer, what would that sort of stuff be covered under?

Answer 1

Medical benefits means everything that is considered medical. If you broke your arm, you insurance will cover that. Now, if you broke your arm, and say you went to the Emergency Room, your health insurance might want you to pay a hefty co-pay. Some insurances state that if you are not admitted into the ER, you will be charged an ER copay.

If you had cancer, your insurance should cover all of your visits. Unless, there is a cap on your insurance. Most known as a 'lifetime max.' This means, that even if you work for a company for 10 years, if your insurance has a lifetime max of $1 million dollars, after your insurance has paid up to $1 million in medical claims, they will no longer pay for anything. But, that rarely happens. (I once had to tell an older lady on the phone that her health insurance would no longer cover her claims as she had reached her lifetime max. One of the saddest things I ever had to do!)

You should really research what type of health insurance you have: HMO, PPO, EPO, POS and so on. If you have any questions concerning your medical benefits, you should contact your Human Resources department, or call your health insurance with your questions.

If you have any other questions, feel free to email me:
[e-mail]

Answer 2

Different policies pay different ways. some policies pay percentages, some pay after you meet a set amout that you pay out of pocket first called a deductible. Some have you pay a set amount of each visit called a co pay. For our office, most patients pay a percentage of office visit and of any procedures done in office, injections and such. For fractures there is a specific charge billed the first treatment visit for the injury and then a global period of 90 days where all office visits, follow ups are part of that global charge. Same applies for surgery patients. Casts and splints that differ from patient to patient fall outside that global charge, but are reimbursed by the insurance at a set rate by contract with the provider and per the patient's policy.

It is very confusing, and each person needs to be a smart consumer and read and know their policy. Out of pocket maximums, max life time benefits and such add even more to the mix.

Answer 3

usually the medical pays for broken arms not sure about cancer in most medical insurance they supply an additional insurance coverage for just cancer at a seperate cost my daughter broke her arm last week and my medical insurance paid for hers