Health insurance companies like to keep secrets. And they like to save money. Example: You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist. Ridiculous, right? You didn’t choose who put you under, so you shouldn’t have to pay extra. But your insurer sent the bill anyway, hoping you wouldn’t notice.
Fighting back against this kind of trickery—and winning—is a lot easier than you think, says Kevin Flynn, president of Healthcare Advocates, a Philadelphia-based firm that helps patients wrangle with their health plans. We checked with Flynn and other insurance-industry insiders, lawyers, doctors, and regulators to uncover nine little-known ways to get the health coverage you deserve—for less.
Don’t pay if you don’t have a say.
When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees. “If you don’t have direct control, you are not liable,” Flynn says, adding that this tack is likely to work every time, but few consumers know about it.
You may be eligible for more coverage.
Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop. One good place to check is Families USA, a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health care advocate for consumers. Another option: Contact your state’s insurance commissioner.
Comments (8)
I want to change our mailing address.
Sydney Holoboff PO Box 116 Libby, Mt. %9923
to: PO Box 6666 Great Falls, Mt. 59405 Effective JUNE 1, 2008
A lot of times the reasons health insurance claims are denied is because the companies employ uneducated claims processors to handle the vast amount of claims. A lot of claims are processed automatically by a computer. Claims are denied not as a scam but because employees are not thorough in their work and are racing to reach benchmarks of claims processed per hour.
I already had insurance, I was approached by two agents trying to get me to change my insurance. I told them i didn’t want to because i was diagnosed with high cholesterol and i had a heart cat. done and was told by my doctor that there was a very mild blockage in one artery nothing serious i was to take a baby aspirin a day. but i really felt like i shouldn’t change ins. at that time. they told me that there company probably would not put a rider on me because i wasn’t even on medication except a baby aspirin i had been on cholesterol med but had been off of it for over a year i was told by the agents that it would not be a problem that half the world had a colestial problem and that the premium might be a little higher they also told me that the insurance that i had at that time was giving people a had time about paying their claims. they told us that they could save us some money and our other insurance was having and increase a couple of times a year. so when they assured me that the most problem i would have was maybe a 12 month rider if they even did that. we went ahead and changed. i went to the Dr. a little over a year after having the insurance, my Dr. scheduled a stress test for my because of my past history with the minor blockage.I was all set up to have this done when i was told by my DR’S office that my insurance would not pay that i had a 24 month rider on me so i waited over 3 years before going back for the test. After over three years i thought everything was fine, my Dr set me up to have another stress test which showed that there was no more blockage than i had almost 7 years earlier he did not understand why they had this kind of rider on me in the first place. let me go back to April because of the situation with the insurance i am now taking stress pills and my blood pressure went up, the other day i received a letter saying they would not pay the office visit because guess what they say in my policy there is exclusion and limitation that excludes benefits for mental and emotional disorders . I know i dont have a mental problem and wasn’t sure what they meant by emotional disorders so i called and was told that they didn’t know why the claim was denied i told the person the only thing i could guess was that now i was taking stress pills and that was a lot to do with them refusing to pay my claims i was totally honest with their agents . I had know idea any insurance companies had that kind of riders. i have known of people seriously ill that have not had riders on them the way i have. the whole problem was we just wanted to make sure everything ws alright. except my blood pressure went up and now i am on blood pressure pills and stress pills what a laugh you take out insurance so you can go to the Dr. before any bad happens and to try to keep yourself from becoming sick or to catch a problem before it does become serious and now you are in worse shape because of your insurance company
I was diagnosed with MS in October 2007.
Now my insurance refuses to pay, because of pre-exsisting conditions.
There are no pre- exsisting conditions in my case. it is just a lot of lies!
Is there a chance for me without getting bankrupt?
I am a 26 year old cancer patient. I’ve been fighting for 2 and a half years. My health insurance company has attempted to deny over 75,00 in health care costs. Fight them and comment on my blog http://baldiesblog.blogspot.com/
I just have had different experiences. In the last 2 yrs. I have had 5 surgeries and have felt nothing but total respect, interest and support from the 3 different doctors. Two were knee replacements and 2 were plastic surgeon where even the plastic surgeon encouraged me to not have any more surgery for a while even though I am a quick easy healer with minimal pain. I know he was looking out after my health and I took it as real concern. However, I have also had appointments with doctors where I never returned because of their manner. Often there is that cocky attitude. I did have an anesthesiologist who definitely didnot want to answer my questions and just blew me off. My doctor later apologized for his behavior.
Why do the money hungry Ins. companys always go after the old and sick, we have paid our Ins. cost for many years, knowing at some time in the future it would be needed, and then we have a GREEDY Ins. company trying to take it away from us.
(What a Shame )
one word of advice..read your policy and know what is covered and what is not.. education is your best weapon