You can potentially save yourself thousands of dollars on medical bills by following these tips!
Even with all the money we pay for our health insurance premiums, many times
we unknowingly pay more than we need. As a former billing manager for a
doctor’s office and a former customer service representative for a major health
insurance company, I’ve seen firsthand the mistakes that cost people money—and
I know how they can be fixed. I was recently discussing insurance coverage with
a friend, and she asked me for some advice about her coverage. She followed my
advice—she spent 15 minutes, and I saved her $95 on a healthcare bill. By
following the same guidelines, you can ensure you are getting the most out of
your insurance coverage so you don’t have to pay even more than you already do.
Make Friends with Your Insurance Company
What your mother taught you is true: “Civility costs nothing and buys
everything.” Sure, the insurance company could have made a colossal error in
processing your claim, or miscalculated what you really owe—but odds are that
the person you are talking to didn’t cause the problem. The customer service
representatives really are there to help you—they are the problem fixers. If
you are very nice and understanding with them, they will bend over backwards to
help you.
Start a Contact Log
Any time you call a healthcare provider or your insurance company, write
down the following:
Date and time you called
Name of the person you talked
to
Type of information he or she
gave you
Any information you send
them.
If you do need to send information by mail or fax, always get the name of
the contact person and send it to his/her attention. Insurance companies have
very large mailrooms, and it is easy for mail to get lost or sent to the bottom
of a huge stack of mail to be opened and hand-sorted. And, if you get incorrect
information from a representative, you may still get credit for a
service—because a customer service representative is responsible for the
information he/she gives you.
Read Your Benefits Booklet
Benefits booklets are dry reading, I know--there’s a reason benefits
booklets aren’t at the top of any bestseller lists. But it is important for you
to have an idea of what your plan covers so you don’t get caught short when you
have a health crisis. If you don’t understand the benefits booklet, call the
insurance company’s customer service—they should be able to explain anything
you don’t understand. You should review your benefits booklet when:
You first sign up for
coverage
When you have a new health
problem
When they send you updates to
your health plan
Make Certain your Provider Charges only what You Owe
Doctors who participate in your insurance plan have signed an agreement that
they will not charge you for more than what the insurance company says they can.
If you have:
HMO (health maintenance
organization)
PPO (Preferred Provider
Organization)
POS (point-of-service) plan,
you will probably be expected to pay a set amount (called a co-pay) for each
visit. With an indemnity (also called “traditional”) or a traditional Medicare
plan, you will pay 100% out-of-pocket until you reach your deductible. If the
doctor’s office tries to collect the total charged amount from you up front,
ask them to call your insurance company and find out how much of your deductible
you’ve met and what the “allowed amount” is. If the doctor’s original fee is
$200, the insurance company may allow them to bill for only $120. And if you’ve
met your out-of-pocket, they can’t charge you anything up front.
Why is this information important? Many doctors’ offices have a policy of
not returning your credit unless you ask for it, and they can hang onto your
money for years, until they finally clear their old accounts.
Look Over Your Healthcare Provider Bills—You Could Even get a Bonus!
I once had a call from a woman reporting that the hospital billed her for
her son’s arm brace, when what he really received was an elastic bandage for a
sprained ankle.
If you find an error in billing, contact the health provider and the
insurance company. Some insurance companies even give a reward to those who
find billing errors that would have cost them money! You will probably need to
ask your insurance company about such a policy because they aren't that widely
publicized.
Examine Your Explanation of Benefits (EOB) Carefully
Your insurance company should send you an EOB for every claim they process
for you. It should show you:
The date you received your
health services
A brief description of the
services
The amount charged by the
provider
The amount allowed by the
insurance
The amount you are
responsible to pay
Remarks that tell how the
company processed the claim.
If the amount you are supposed to pay seems too high, call the insurance
company. Sometimes insurance companies reject claims because the doctor’s
office billed with the wrong billing codes, other times the insurance company
may be waiting for you to supply them with more information. With just a few
phone calls, you can hopefully have the claim corrected and reprocessed
quickly.
If Your Claim is Denied, Consider Filing an Appeal
Many group plans are funded directly by the company for whom they work, and
the plan is simply administered by the insurance company. What this means is
that your place of employment will have final say over whether a service is
covered. If there are special circumstances surrounding the type of medical
services you received, your employer may tell the insurance company to allow
the charges for you as a special case.
Call Your Insurance Any Time Your Family Situation Changes
All of the following can affect coverage for anyone listed on your insurance
plan:
Deaths
Divorce
Births
Adoptions
New jobs
Loss of jobs
Graduations
Many plans stipulate that you have only a certain amount of time to add or deduct
family members or change your plan. If you wait too long, you may not be able
to get a member covered until open enrollment for your plan begins—which could
be several months away. Meanwhile, you will be responsible for all medical
expenses for that person until they become covered; sometimes even after if
they develop a medical condition. If the condition is serious, you could easily
end up with a bill for tens of thousands of dollars.
If you have a member who is going to college, he or she could still qualify
for coverage under your plan. Depending on where the child goes to school, you
will have to contact the school’s registrar office and possibly request an “out
of area” waiver so he/she can see doctors close to the school.
Don’t Assume More Insurance is Better
It's a fallacy to think that if you have the opportunity to have two health
insurance policies, you would be very well covered for any medical
catastrophe—you can end up paying more than if you had only one insurance plan.
If an insurance plan is secondary, they cover you and your family differently
than if they were the primary plan. The insurance business calls it
“non-duplication of benefits,” and what it amounts to is this: if the primary
insurance pays as much as or more than what they would have paid if they were
primary, they pay nothing. And you certainly don’t want to pay contributions or
premiums on insurance that pays next to nothing.
In some cases, secondary insurance can actually make sense, such as when
you:
Need care the primary won’t
cover
If a specialist isn’t covered
on your primary
Your primary insurance is
very restrictive
Your secondary insurance does
not have the non-duplication of benefits policy
Your secondary premiums or
contributions are very low or nonexistent.
Another option is to sign up for a Flexible Spending Account, which allows
you to save pre-tax dollars specifically for medical and medical-related
expenses. Your employer will have more information, if you are interested.
If You are Traveling out of the Country, Make Certain You are Covered
Many insurance plans, including Medicare, will not cover medical expenses
incurred outside the U.S.
Some, such as Blue Cross/Blue Shield, do—and they may even have participating
providers in the country you are visiting. If your plan won’t cover you during
your travels, you may want to consider signing up for travel insurance. You can
purchase medical travel insurance for as little as $49 per person—a pittance
compared to the cost of emergency care and/or medical evacuation, should you
need it.
If You Suspect Your Insurance Company is Fraudulent, Get Help
If you cannot get your insurance company to respond to any of your concerns
or cannot get them to pay your claims, you can contact your state insurance
commissioner’s office. If your benefits booklet does not have the address for
the insurance commissioner in your state, you can locate it by going to
www.naic.org. This website also has other information that can help you resolve
your problem with your insurance company.
I guarantee you that at some point either your healthcare provider will make
a billing error, or your insurance company will make a mistake in processing
your claim—but there is no reason you should be the one to pay for it. Now that
you know how to start, you will be able to pay less for staying healthy.