How much insurance companies actually pay for accidents, cancer treatment, or surgery depends on what kind of insurance you have, but there are usually limits. Here are some facts to consider:
Cost of illness. Most insurance companies have a cap on how much they will pay for a long-term illness. A recent survey found that 10 percent of people with cancer have hit their lifetime cap and are no longer covered by insurance. Looking forward, however, the new health care reform law will eliminate caps on lifetime insurance by 2014.
Emergency room cost. If you have an accident that requires emergency treatment and you end up in an emergency room outside your insurance network, you may not be covered. One study found that HMOs in California denied one out of every six claims for emergency room costs.
Surgical coverage. You may be surprised at what your insurance company considers non-covered surgery. There can be a big gray area between covered “reconstructive” surgery and uncovered “cosmetic” surgery. Even when surgery is covered, your deductible may be $500 or more, and you may still be responsible for up to 25 percent or more of surgical costs, depending on the specifics of your plan.
