A Guide to Health Insurance

Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

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Navigating the System / Getting care, what's covered
If you are having a health emergency, you do not need to get permission to access emergency care. Health plans do not require permission or authorization for a sick or wellness visit with a primary care provider. Prior authorization from your insurance company is different from receiving a referral from a primary care doctor. Some services require prior authorization in addition to a referral. Prior authorization gives the clinical staff at an insurance company the chance to review treatment…
Navigating the System / Getting care, what's covered
Most health plans cover some chiropractic care for acute or short-term conditions. New Hampshire statute requires health plans that cover chiropractic care cover a minimum of 12 visits. You may be required to pay a co-pay at the time of your visit, so be sure to check your Summary of Benefits and Coverage Document. However, many insurance plans do NOT cover chiropractic care for maintenance and wellness treatments. If you are being treated for a chronic, long-term condition, refer to you…
Navigating the System / Getting care, what's covered
Yes. In fact, most health plans must cover a certain set of preventive services at no cost to you, when delivered by an in-network provider. Screenings and Counseling Screening for diabetes, cholesterol, obesity, various cancers, including prostate, HIV, and sexually transmitted infections (STIs) Counseling for drug and tobacco use, healthy eating, and other common health concerns   Routine Immunizations Recommended routine immunizations for adults and children…
Navigating the System / Getting care, what's covered
There are many resources available to help you find behavioral health care or substance use disorder services. If you or someone you know is in crisis and need help immediately Call 911 in case of an emergency or life threatening situation. If you’re in New Hampshire, you can call 2-1-1 for immediate help 24-hours a day, 7 days a week The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-TALK (8255). A trained counselor will help you with any problems you are…
Navigating the System / Getting care, what's covered
Alternative health care services are health treatments that are not typically provided in a traditional Western medicine practice. There are a wide range in practices, but typically these services focus on creating health through balance between mind, body, spirit, and environment. Research can help you understand the pros and cons of alternative care options. There are different categories of alternative health services.  “Complementary” treatments are used with standard medical practices…
Navigating the System / Getting care, what's covered
Keep in mind, health plans only cover what they consider “medically necessary.” For example, plastic surgery would not be covered just because you want to improve the way you look. But, it would likely be covered to fix a problem (even if afterwards you like your nose better).                                      Major medical type commercial health insurance is linked to covering health care services, not disease conditions.  When the service is medically necessary and covered under the…
Navigating the System / Getting care, what's covered
H ealth insurance is not always easy to understand. Take some time to find out what your insurance will pay for and learn how to use your coverage. Be on time with your premium payments If you bought health insurance yourself, you should get the first bill from your insurance company within 10 days of signing up. You could lose your coverage if you don’t pay your premium on time every month. If you don’t receive a bill, call customer service and ask about it. If you have health insurance…