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Get the Maximum Use of Your Insurance Dollars

Health insurance companies like to save money. For example, when you have surgery, you might get a bill for using an out-of-network anesthesiologist. But you shouldn’t have to pay extra for a matter you had no choice in.

Fighting back against this kind of trickery is easier than you think. Here are some little-known ways to get the health coverage you deserve.

Don’t Pay If You Don’t Have A Say

If the above situation happens, draft a strongly worded letter stating you had no say about the anesthesiologist and won’t pay any additional fees. This is likely to work every time, but few consumers know about it.

You May Be Eligible For More Coverage

You could be eligible for more benefits than your plan is telling you about. It’s unlikely that your plan is letting you know about state-mandated coverage, for example. One good place to check is Families USA (www.familiesusa.org), a consumer group that keeps tabs on state rules.

To Get Tested, Talk Up Your Symptoms

If your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, mention to your doctor that you’ve had some blood in your stool and a lot of gas lately -- or even just that your bowel habits have changed. Your plan has to pay for the test if you have these complaints.

Stall First, Answer Questions Later

Companies sometimes look for info you may have accidentally omitted when you applied for coverage. If an omission is found, you can be denied coverage. Don’t answer questions that sound like fishing expeditions.

Letters Are Your Best Bet

The old-fashioned letter is by far the best way to communicate with your health plan. If you use the phone, it takes forever and when you’re done there’s no record of it.

Doctors Can Be Good Weapons

Ask your doctor for help. He can tell the insurer he’s going to complain to the state board that regulates health plans.

A Little Research Can Go A Long Way

Arming yourself with info doesn’t guarantee coverage, but it’s a proactive step in the right direction.

There Are Ways To Get Drugs Cheaper

In many cases, drugs have generic versions that are just as effective but cheaper than the newer ones. Always ask your doctor (or the pharmacist) for generics. And if you really need a medicine that doesn’t have a generic version, order it by mail; many plans have a less-expensive mail-order pharmacy option.

An Advocate Can Help You Win

Some patient advocates help you interact with your doctor, while others specialize in insurance disputes. Advocates can even get policies changed.



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Article's Comment     ( 18 Comments )
 
 
 +16 Points           
 
Author of the Article
BY foxtroter   
  
[ Joined on 09/06 ]
[ Posted on February 08, 2008 ]
Post Reply
While it is all true.  Most people with insurance wouldn't be having to use it if they chose to make lifestyle changes. 

One of the consequences of sodas, cigarettes, alcohol, white flour etc. . .  is that you increasing your chances greatly of getting to play a frustrating game with your insurance company.

1/3 of a doctor's office overhead is just involved with billing and collecting from insurance companies. 

In my chiropractic practice I have two businesses.  The primary business is getting people well.  The secondary business is fighting with insurance companies to make them pay.  We have to rebill over 50% of our billings to force full payment. This includes Workers's Comp, MediCare, Personal Injury and Private Insurance. They often will pay a little of the bill thinking you will go away, accept what crumbs they throw at you and let the doctor then try to get the poor patient on fixed incomes to come up with the rest.

It must pay insurance companies to pay improperly the first time as many doctor's office will not fight to make an insurance company pay what they should.  After all, it is the patient's insurance and not the doctor's insurance

Unfortunately, few people are up to the battle of fighting regularly with their insurance company.  Most often patients have no idea what their insurance company should pay and just assume that what their insurance company pays is all that they are entitled to.

I feel sorry for patients who do not have a physician who is willing to spend his time and hire staff to fight for the patient's insurance company to pay.  It is easier to just send the patient a bill and turn them over to collection.
 

 +3 Points           
 
Author of the Article
BY Patty D   
  
[ Joined on 06/07 ]
Author of the Article [ Posted on February 11, 2008 ]
 
Dr. Fox, boy do I agree with what you are saying from both sides...as a patient and now working in medical billing.  I started seeing my chiropractor the end of last April (I have Medicare).  They initially denied everything and you've read how sick I was.  They finally got 2 months paid.  I just got an EOB 2 days ago, and they paid for July.  I feel really bad for my chiropractor.  I'm just one patient and he has to deal with this with all of them?  On the billing side, I spent the entire day gathering data and resubmitting claims, some going back to 2003.  It's ridiculous!!!

 
 +13 Points           
 
Author of the Article
BY mama bear   
  
[ Joined on 06/06 ]
[ Posted on February 11, 2008 ]
Post Reply
I hate health insurance because it is not "health" insurance at all but "dis-ease" care.  Here in the US we have allowed our employers to dictate our health coverage.  The insurance companies do not pay for medical massage, accupuncture, often not chiropractic,  and other "not approved" methods.  I know they work for me and my family but we end up spending discretionary funds on wellness.  Health care coverage is great if you have trauma or an emergency but it doesn't work for wellness coverage.  Most wellness coverage consists of "well baby " visits to get shots.  
 

 +5 Points           
 
Author of the Article
BY qualitygeek   
  
[ Joined on 10/07 ]
Author of the Article [ Posted on February 11, 2008 ]
 
Insurance companies are in the business of making money, not paying claims.

Ask your employer about HSAs. If they are clueless, refer them to Paul Zane Pilzer . If your employer does not offer health insurance, you can still opt for an HSA with private insurace. Pilzer describes an HSA as an IRA or 401K on steriods.

 
 +8 Points           
 
Author of the Article
BY Aaltrude   
  
[ Joined on 04/07 ]
[ Posted on February 09, 2008 ]
Post Reply
I'm waiting for the day (but I'm not too hopeful) when health insurance companies will assess your health risks from to your lifestyle and charge accordingly.

 
 +3 Points           
 
Author of the Article
BY New to Natural