How To Make Your Health Insurance Company Take Care Of You
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Americans are under attack. Not by other countries. Not by cybercriminals. Well, also those things, but today, we’re talking about a threat that’s coming from the inside. It’s a much more heartless, much more menacing and far more dangerous entity that poses real threats to our lives every day: our very own medical system. The PEW Trust found that 43 percent of American adults are inadequately insured. And the ASPE found that there are more uninsured Black Americans than white Americans.
In this country, facing even a modest health issue can be financially devastating. Staying alive and healthy can mean wiping out your savings. Meanwhile, Life 5 News reports that the health insurance industry is getting richer than ever, with unprecedented profits this past year. If health insurance companies allegedly pay for pricey procedures, medicines and more, how do they keep fattening their pockets?
This could be one answer to how medical insurers get richer as we get sicker. Research from the American Association for Justice found that insurance companies operate under the mandate to look for any excuse possible to deny a claim. They’re in the business of keeping money – not giving it away, as their commercials would make you think. There are even rumors that claims adjustors with the highest numbers of claims denials are given monetary rewards and incentives. Your health insurer is not on your side. Don’t let that cheery jingle in their commercials fool you.
On Universal Health Coverage Day – a United Nations initiative demanding that all countries provide its citizens with affordable health care – we in America continue to have to advocate for ourselves. Here are ways to make your health insurance company do what it’s supposed to do—insure your health fully.
Get Everything On Record
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A phone call does not provide the evidence you need that a claim should have been covered. When you speak to your insurance company – either before a procedure when getting approval or after it – take notes of every piece of information you need in writing. Then ask the adjustor to send you an email with those pieces of information. You may also have the right to record the phone call, depending on which state you live in. In some cases, you must get verbal consent from the adjustor.
Go into conversations with your insurance company with the understanding that one day, you might need to use what they said against them in a claim – if not a lawsuit. And remember: they are recording the phone call. So you might as well, too.
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Check Your Invoice
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Research reported on Etactics shows that as many as 80 percent of medical bills contain errors. And those errors can cost you. You might be charged for miscellaneous services and medications that you did not receive. You might be charged for an out-of-network provider when an in-network provider was used. Ask your insurance company or provider to give you a fully itemized bill and look at everything closely before paying a dime.
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Check If All Staff Is In-Network
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If you are scheduling a procedure at a hospital, ask if all of the staff that will be involved in your care is in-network. In many cases, patients schedule surgery with an in-network surgeon, but are later sent a massive bill including out-of-network anesthesiologists, pain management specialists and other providers. Know exactly who is and is not in-network in terms of your care staff. If someone is out of network, ask if you can arrange for an in-network alternative. If that is not possible, ask your insurance company to negotiate a price with the out-of-network provider before the procedure. Once it’s been done, you don’t have much negotiating power.
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Sometimes, Don’t Use Insurance
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Dealing with insurance companies is a pain in the ass not just for patients but also for providers. That is why some doctors actually offer a discount for patients willing to pay in cash. What this means is they might charge you a cash price for the service that would be lower than your co-pay, should you use insurance. Anecdotally, there are cases of doctors charging over a thousand dollars to an insurance company for an allergy shot – or just $200 to a cash-paying patient. Ask your provider if they offer cash discounts.
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Never Cash A Premium Refund Check
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If you ever receive what is called a “premium refund check” from your insurance company, do not cash it – at least not until speaking with them to ask why they sent the check. And (as always) get that reason in writing, and confirm you’ll still be covered if you cash the check. Some insurance companies send these checks as a way of dropping you. If you accept a refund on your premium, then (sometimes) you are technically not paid up for coverage, and the insurance company can deny your claim.
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Keep Fighting With Your Health Insurance
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Deny and deflect. Those are the orders from insurance companies to their claims adjustors. They know that most patients will just become exhausted with the phone trees, filling out forms and the waiting for approval and on and on. Get ready to fight. If it seems like your insurance company is trying to tire you out – they are. Show them that it can’t be done. Mentally prepare yourself for battle and find something to keep you busy while you wait on hold through many phone trees.
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Ask Your Provider To Advocate For You
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Sometimes, your doctor can be your advocate. Certain doctors are willing to do this. If your health insurance company is being wishy-washy or stubborn about not covering something, tell your doctor. They have certain codes they can put in the system that will mark your procedure or medication as essential and even urgent. Much of how your insurer decides to cover something comes down to how necessary your doctor says it is.
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Know Your Rights To Appeal
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Just because your insurance company has denied a claim doesn’t mean you have to accept that. Know that first off, the insurer must tell you in writing why your claim has been denied. They are also obligated to inform you that you have the right to appeal. Then you can appeal internally. If (and likely when) that doesn’t get results, you still have the right to appeal externally. The U.S. Department of Health & Human Services says that you have the right to request that a third-party review your appeal and make the final decision on whether or not the insurer must pay your claim.
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Find Advocates Outside Your Health Insurance
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Your health insurance company might provide you with what they call a “patient advocate.” This person is allegedly there to advocate for you. But…they are on the insurance company’s payroll, so it’s kind of smoke and mirrors. If you believe your insurance company is doing something unethical or illegal, your best course of action is to find an outside advocate. This can be a government advocate, a non-profit advocate and even an attorney if necessary.
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