Health insurance is an important key to protecting yourself and your finances, but it is also important to realize that you need to make sure that you claims are paid, and that the doctors and hospitals are charging you the correct amount for the services. There are a lot of mistakes made when it comes to insurance claims, and this can cause the insurance to deny coverage on your bills. You need to monitor your insurance claim and bills. Do not just throw away the papers and figure it will work itself out. You are responsible for staying on top of your healthcare costs and making sure each bill is paid.
First, you need to make sure that you receive pre-approval on any major medical procedure that you have done. Pre-approval means that the insurance is willing to pay to have the procedure done. This includes most tests (aside from routine blood or lab work) and surgeries. It may also be required for therapy sessions, such as physical therapy or occupational therapy. Your doctor will usually handle this, but you can call and talk to your insurance company before the procedure to make sure everything has been processed.
You should carefully read any statements that you receive from the hospital. These statements often come within a week of being at the hospital. These statements list all of the procedures and medications that you received while at the hospital. You should look over this and make sure that you did have every procedure listed. If you find any discrepancies, call the hospital or doctor and request that an inquiry be made. You can also request a more detailed statement. For example, it may say that medication was administered and the more detailed statement lists the type or the dose.
Next, you need to watch for and read your EOBs (explanation of benefits) from the insurance company. You need to compare them to the statements and bills that you receive from the hospital. You should see the price that the insurance is willing to pay for the procedure. You should also see the amount you do not owe (which is the amount that the bill was for minus the agreed on price with the insurance). You should also see the amount that you do owe. This is the amount of any coinsurance or deductible. If they refuse to cover a service you will need to contact your insurance company to dispute the refusal to pay.
Finally it is important to realize that you can shop around for your medical care and lab services. You can find places that offer the same services at a lower price. You can call and find out what the prices are before you schedule an appointment. This is especially worth the effort if you have a high deductible insurance policy. You may find that some doctors will only charge $75.00 for a sick visit and others charge $125.00.
Pay attention to the doctors you choose. You can save a lot of money by staying within your approved network. It's worth the extra effort to do this.
If you are out of town and become ill, call your insurance company to see which doctors, if any, are covered in network. If it is an emergency you may have to go directly to an emergency room. Most emergency care is covered, but it may be at out-of-network costs.
What You Need
- Hospital statements and bills
- Explanation of benefits from the insurance company