Health insurance plans are complex and use specialized language and processes. Medical paperwork can be overwhelming and confusing. Rather than wait until you're facing a serious medical condition and the bills are piling up to understand the medical insurance and paperwork maze, invest some time now in understanding your insurance coverage and setting up a system for your medical paperwork.
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Be an Informed Consumer
Block out time on your calendar to read your insurance plan, especially the section on exclusions. If you don’t understand something, call your insurance company, your employee benefits representative, your doctor, your hospital or whoever sent the material, and ask questions. Keep asking until you get the information you need. Schedule time during your day to make the necessary phone calls. Be patient, but persistent.
Understand Your “In-Network” Benefits
If you’re in an HMO, use your primary care physician to get referrals to specialists. If you’re in a PPO, use network hospitals and physicians. Your hospital may be in-network, but individual physicians may not. Be sure you know which is which. Use network retail pharmacies and mail order prescription plans for your medications. It can be an expensive mistake to make out-of-network choices, so carve out time to do your research.
Keep Good Communication Records
Document everything! Keep records of all phone conversations with dates, who you talked to, and what they said. This makes follow-up calls easier. Keep copies of anything you send or receive. Documentation also matters if providers file insurance claims late. You may be able to have late bills written off if you gave your provider your insurance information and they failed to file on time.
Pay Only What You Owe
Keep track of what tests, procedures or items you receive at each medical visit or hospitalization, or ask a friend or loved one to assist with this. Review medical bills for accuracy. Request an itemized bill of your charges, making note of the date you called and by when you’re promised the information. Check for duplicate charges, charges for procedures or items you weren’t provided, unexplained miscellaneous charges, or other confusing items. Insurance and provider errors are common and can cost you a lot – match your bill to the Explanation of Benefits from your insurance company, and compare coverage to your insurance plan. If claims are not covered, call and ask why. Ask your insurance representative to re-process your claim. Be persistent.
Ask for Help
Seek the help of a family member, trusted friend, or medical claims professional if you are unsure how to proceed. Look for someone who is organized and persistent and who advocates for you. You can succeed with persistence, patience, and assistance.
Guest Columnist Myrna Cortez is president of ProMediClaim, Inc., a medical claims advocacy company resolving issues for individuals and families for more than 30 years. You can reach her at firstname.lastname@example.org.