Struggling to Understand What is Covered

question mark Why do health insurance companies make it so difficult for people to find out what, exactly, their policies cover? My previous attempt to figure this out resulted in frustration. I’m giving it one more try, before I start trying to call my insurance agent.

I’ve been looking through the booklet that my health insurance company sent to us. It is huge! I thought it would be filled with helpful, useful, information, that would be easily accessible. Instead, the first 50 pages or so are basically copies of “paperwork” that don’t tell me anything that I really want to know.

All I want is the answer to one, simple, question. What does my health insurance actually cover? I cannot understand why this has to be so difficult to discover.

Fifty-some pages into the giant booklet, there is a page that says “Your Quick Start Guide. Ten easy tips to help you get the most out of your new plan.” What follows are ten sections that you can skip to, based on what you are trying to figure out about your health insurance. The seventh section is called “Reading your explanation of benefits”. This sounds like where I should start.

This is definitely a “quick start” guide. It shows a picture of one of those “this is not a bill” forms that insurance companies send out. It points out different sections, and does a nice job of explaining everything that it is important for me to know about this type of statement. It doesn’t actually explain what my health insurance covers, though.

Thirty pages later, I find a copy of my insurance policy. Finally! My insurance covers two office visits from Participating Providers in a year. I think there is a co-pay involved in this. Is my doctor a “Participating Provider”?

I tried to find this out through the website of the insurance company, but it was too difficult. A quick call to my doctor’s office provided me with the answer I was looking for. Yes, they are “contracted” with my insurance company! What a relief!

This means that my insurance will cover “preventative care”, (without making me pay the deductible, or coinsurance, to get it). Unfortunately, there isn’t anything in the entire booklet that specifically states exactly what is considered to be “preventative care”. Looks like I need to call my insurer to get this information. Why can’t they just put this information in the booklet?

Image by Ceasar Bojorquez on Flickr

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About Jen Thorpe

I have a B.S. in Education and am a former teacher and day care worker. I started working as a freelance writer in 2010 and have written for many topics here at