Insurance Companies

What is Kaiser Permanente?

Kaiser Permanente, often referred to as Kaiser, is one of those names in health insurance circles, perhaps similar to Blue Cross, that many people know and relate to and trust. Kaiser issue a wide range of health insurance plans and policies, many of which may change will be subject to review owned current health insurance reforms. This is true of all plans and policies that are issued by all health insurance companies and associated bodies.

There is perhaps a more important need for individuals to understand the type of plan and policy that organisations such as Kaiser Permanente will be offering, in order for the individual to assess their own needs and whether such health insurance plans and policies meet these needs.

There are a number of health insurance terms that are used widely within health insurance plans and policies that it is a good idea to have an understanding of. Virtually all health insurance plans have a long list of exclusions of certain types of condition and areas of medical intervention and help that they are not willing to provide financial benefit for.

Knowing what these exclusions are in advance of taking out a health insurance plan allows the individual to assess whether or not it is the right plan for them, and if so where they might be able to obtain the medical intervention that the health insurance plan excludes in a different context. All health insurance companies operate their plans and their policies on the basis of what they refer to as prior authorisation and interventions being medically necessary.

Kaiser Permanente

These terms can seem a bit odd to people who have had health insurance before or have not been that familiar or have not had to take advantage of the health insurance plan.

The intent behind prior authorisation, is that the insurance company must decide prior to any type of medical treatment for intervention taking place that they agree to pay for it under the terms and conditions of the insurance policy. In addition the phrase medically necessary which goes hand-in-hand with the phrase prior authorisation, means that the insurance company is the ultimate determinant of whether or not any intervention is deemed medically necessary or not.

What this in effect means, is that it is the insurance company who decides whether or not you as a policyholder need any medical treatment, and you must get that agreement to that treatment prior to taking place. The insurance company will also determine, by way of providing a prescribed list, which health care providers and institutions are able to perform any medical treatment which they will agree to pay for under the terms and conditions of the policy.

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