It's hard to answer this question without knowing more details about a specific situation related to determining patient benefits eligibility. Since the country of origin, the health care system in that nation, and the personal details of a patient's situation all factor in here, it's only possible to generalize about the appropriate steps to take when insurance does not cover a planned service. The healthcare system in your country will have specific rules, for example:
• Canada has a government-run health care plan that entitles almost all citizens to the health care they need. The only exceptions to this general service rule may occur when a patient applies for disability benefits, or other similar benefits. It can be difficult to know where to turn if a Canadian patient applies for disability and is rejected. A patient may need to retain a lawyer to challenge the system, or get reference letters from doctors who can attest to their level of disability.
• In most private health care systems, the procedure will be different. Health care provider companies will have detailed insurance contracts that lay out the details of exactly what is (and what is not) covered. In general, simply by reading the fine print, a patient can figure out where he or she stands, in terms of patient benefit eligibility. However, the system can fail people. Companies tend to put profits ahead of proper health care at times. If this happened to you, legal guidance may be necessary to assert your rights. If the contract is ironclad, there may be no legal recourse.
When all else fails, turn to the community, who may be willing to help you with fundraising or donations that will help you afford a denied health care service or treatment for yourself or a friend or loved one.
• Canada has a government-run health care plan that entitles almost all citizens to the health care they need. The only exceptions to this general service rule may occur when a patient applies for disability benefits, or other similar benefits. It can be difficult to know where to turn if a Canadian patient applies for disability and is rejected. A patient may need to retain a lawyer to challenge the system, or get reference letters from doctors who can attest to their level of disability.
• In most private health care systems, the procedure will be different. Health care provider companies will have detailed insurance contracts that lay out the details of exactly what is (and what is not) covered. In general, simply by reading the fine print, a patient can figure out where he or she stands, in terms of patient benefit eligibility. However, the system can fail people. Companies tend to put profits ahead of proper health care at times. If this happened to you, legal guidance may be necessary to assert your rights. If the contract is ironclad, there may be no legal recourse.
When all else fails, turn to the community, who may be willing to help you with fundraising or donations that will help you afford a denied health care service or treatment for yourself or a friend or loved one.
