104. What are the characteristics of a point of service insurance plan?

This is the traditional insurance coverage that was, until recent years, most common. The insurance company determines what types of services are covered under your health care plan, and the credentials required of providers. Typically, health care providers must be licensed to practice their specialty in the state in which they practice, and their profession must be qualified to provide the services rendered (based on their license). You may choose any licensed provider in your community. You may choose a specialist out of your area for treatment. Coverage is based on a percentage of the usual customary fee for that service in your area. You are responsible for part of the fee, and usually also have to pay an annual deductible. Sometimes there is an annual maximum dollar amount of coverage, or a maximum fee per service, or a lifetime maximum coverage for services. If the insurance company feels that treatment is not necessary, they can request a review by the state licensing board, or use other  acceptable practices for reviewing treatment necessity.

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