We know health insurance language can be tricky. We're here to shed some light on things so you can better understand your coverage.
Covered services are paid for according to the cost-sharing rules outlined in your plan. This means you'll have to pay for these services until your deductible is met, and you'll have to pay a copay or coinsurance until your out-of-pocket max is met. Click here for more information on copays, deductibles, coinsurance, and out-of-pocket maxes.
100% covered services are entirely covered by your plan at no cost to you! This includes a lot of preventive care such as annual physicals, immunizations, well-woman exams, some types of birth control, and some primary care depending on your health history.
These are services that aren’t covered by your health insurance plan. This can be because the procedure or service isn’t deemed medically necessary or is specifically excluded from your plan (refer to your Summary Plan Document for General Limitations and Exclusions). If you receive these services, you must pay for them on your own and payments do not count toward a deductible or out-of-pocket max.
If you feel that a not covered service should actually be covered, and a claim denial was a mistake, feel free to reach out to Sana. Sometimes this can happen if we don't have a prior authorization on file or a diagnosis code doesn't match the treatment. Click here to learn how to submit an appeal.
If you have any other questions please feel free to call us at (833) 726-2123 or send an email to email@example.com.