We all know health insurers hold back information in order to save some money. Example: Let's say you get surgery, and a couple weeks after you get a bill for utilizing a "out-of-network" anesthesiologist. If your not the one who selected who put you under, how come you have to pay extra?! And your health insurance rate company sends the bill anyway, thinking maybe you wouldn't notice.
Opposing can be rather tricky, and winning will not be as difficult as you think, says Kevin Flynn, the president of Healthcare Advocates. Here are some points that hopefully will help you get the MOST out of your health insurance rate.
1 - You may be eligible for additional coverage! Dependant on the state you reside in, you could be eligible for more then you health insurance rate tells you! Let's look at the state of Maryland. Healthcare plans operating in Maryland have to pay for infertility coverage. BUT one state over, in Virginia, they don't pay for infertility coverage. Even though, It's not very likely that your plan is trumpeting info about state-mandated coverage. It's going to be up to you to get the scoop. One good place to look is familiesusa.org, a consumer group that helps keep tabs on state rules.
2 - To get tested, you have to talk up your symptoms. Your health insurer doesn't want to pay if they think it's unnecessary. But if you know you need one, this is how to get it covered: Speak to your doctor in detail about your symptoms and why it is you think you need the test.
3 - Letters! It may sound inconvenient, but an old-fashioned letter is one of the best ways to communicate your to health insurance rate company. DON'T do anything over the phone. It takes forever and when you're done there's no record of it, so it didn't happen.
Letters almost always get a response. Even though there are some health insurance rate companies that will answer email, there are many that don't.
Who exactly should you address the mail to? Experts recommend following your insurer's appeal process for letters and also sending copies to your state insurance commissioner. And keep copies of every letter you have sent out to your insurer AND whatever they send back. This way, when your insurer decides to say, "We never said we'd cover that," you can say, "I have it right here in writing."
4 - Doctors can be good weapons. Let's say you just got three massage sessions, UNDER doctor's orders, for lower-back pain. And your health insurance rate company refuses to pay for them?! You can ask your doctor for help. He can tell the insurer he's going to complain to the state board that regulates health plans.
5 - Caveat: Don't contact your state board yourself if a claim is denied. Janice Weiss, of Jupiter, FL-says some of her clients who had gone this route ended up hurting their cases when the state agency had ruled their claims invalid; which left them little recourse with their healthcare companies. Instead, while working your plan's appeals process, just suggest you may take the matter to the state.