Dealing With Your Medical Insurer

If you ever face a medical crisis, you’ll be amazed at how quickly the bills mount up, even with great insurance. You could argue about whether insurers are inherently evil, coldhearted, or callous, but the bottom line is that insurers are businesses that want to get the most money they can out of you. Sometimes you will have to pay and there’s no way to get around that. However, there are so many mistakes, wrongly denied claims, double bills, and unnecessary charges at times that you may be able to reduce your bills somewhat, but only if you’re prepared to fight. Your insurer isn’t going to suggest ways for you to reduce your bills and they aren’t going to help you very much. Your insurer hopes that you will just pay the bill. You want to question everything and only pay what you need to. Here are some ideas if you ever need to go to war with your insurer.

Know your benefits before you need them

Chances are your insurer sent you a benefits guide when you got your policy. Chances are that you threw it in a drawer. You need to take it out and read it cover to cover before you need medical care. Read everything they sent you, and keep up when they send you amendments. Know what’s covered and what’s not, know what doctors and hospitals you can use, and know what procedures require pre-approval. You hope that you’re wasting time by reading all of this boring stuff, but if you ever find yourself in the midst of a major medical crisis, all of that knowledge will make things go a lot smoother for you. Just the simple act of telling the ambulance driver to, “Take my husband to hospital X, not hospital Y because that’s where are insurance is accepted,” will make things much more affordable and easy for you. If you don’t read your guide, though, you don’t know what to ask for.

Understand what you must do to get procedures approved

For anything beyond routine and emergency (life or death) care insurers vary widely on what you need to do to get procedures approved. Some simply require your doctor to note that the procedure is necessary. Some require a second or third opinion. Some require waiting periods or other hoops to jump through. Know what you have to do to get approval and make sure you follow those steps exactly. Also keep notes of the steps, dates, whom you talked to, etc. so if there are any disputes you can prove you did what the insurer required.

Be persistent

Persistence pays off in many cases, but it can be hard. You sometimes have to outlast a big, bureaucratic machine and it can be exhausting. If you don’t get the answers or resolution you need on the first call, you need to be prepared to call back again and again, and to work your way up the chain of command. You need to write letters and emails over and over again. You have to keep after the insurance company until you get all of your questions answered and your disputes are resolved.

Enlist your healthcare provider for help

You doctor can be a great ally in your fight. He or she can sometimes step between you and the insurer, offering detailed explanations as to which procedures were performed and why. The doctor can attest that the procedure, drug, or material was required and they can speak to your efforts to get things pre-approved. Some doctors won’t help you much, but if you have one that is willing to step in, their words can be more convincing than yours.

Get organized

Make a spreadsheet or notebook to keep track of everything. Note phone calls, dates, and names of people you talked to so you can reference any promises or disputes. Mark off charges as they are paid (either by you or the insurer) so that you can tell if they reappear. Keep records of everything related to your healthcare and claims so that you always know exactly what is going on and who is getting paid what. Confusion only works in the insurers’ favor. They have huge databases that track everything related to your claims so they always know what’s going on. You should do the same. Keeping good records will also help you at tax time if you end up able to deduct any uncovered expenses.

Understand the appeals process

When you read your benefits guide, pay close attention to the section on appealing. There will be an explanation of what you need to do if you think a claim is wrongly denied or processed. It will spell out how long you have to lodge an appeal and exactly what you must do. Know this process and follow it exactly. If you deviate from their steps, they will only deny you again.

Read every bill and compare them with past bills

When you get a bill in the mail, read it thoroughly. Don’t just toss it on top of the heap. Then get out your older bills and your notebook or spreadsheet and compare them. Look for any charges that keep reappearing after you’ve already paid them. You already paid the bill for the anesthesiologist but look, there it is again. Don’t pay it a second time. Call the insurer, offer up your proof of payment and ask that they stop billing you for that. When medical procedures mount up, it gets harder and harder to detect multiple charges for the same things without good records. So keep your records and constantly compare new charges with old charges.

I’m not suggesting that you shirk any legitimate charges. If you had the service, you do need to pay. However, you don’t have to pay for mistakes or things that were wrongly denied. Insurers are notorious for double billing, overcharging, and denying legitimate claims. Know your rights and fight anything that you think you shouldn’t have to pay. It can save you a small fortune in medical bills.

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