Dealing with health insurance can make you sick. Will health providers and insurance companies give you the coverage you've paid for? How can you survive this unhealthy bureaucracy?
While we haven't had any illness more serious than Annette's kidney stone, emergency room trips and sick visits for the kids, we've found a few tricks to get providers to deal fairly with us. These methods have kept us from feeling victimized by some massive and incompetent organizations.
Know Your Policy
Know what's covered and excluded. Communicate your limits with your doctor. Try to get the most care for the least money.
Some covered procedures aren't listed in your benefits book. Years ago, one of our kids needed occupational therapy. It wasn't listed as a covered service. Annette called the insurance company and discovered that they covered this service. It needed pre-approval, but that was a minor inconvenience for covering six months of services.
Follow Up Bills
Insurance companies and doctor's offices don't always communicate. Annette once found, after several calls, that the insurance company hadn't received any claim information from our doctor. She discovered that the doctor's office personnel weren't operating the fax properly, and information wasn't reaching the insurance company. Transmittals, claim forms and other documents are often "lost" or "not received" by the insurance company. Calling right away can prevent delays and let everyone know you are paying attention.
Take Names and Notes
Copy everything you submit. For larger claims, we create a file folder for all paperwork. Staple a sheet of loose-leaf to the inside cover and track all phone communication. Take names and get direct phone numbers. Having one person who actually knows your situation saves time and effort. We've been able to document dates, number of contacts, and how often our calls went unreturned. People are amazed at our detailed information.
Keep Your Records
In Arizona, hospitals have six years to review records and correct bills. It's not good business, but unfortunately, they have lobbied to protect themselves. This particular "loophole" doesn't apply to Medicare patients.
Annette's 1999 kidney stone experience took over four years to resolve. Two years after the account was "closed," the hospital audited its files and billed us for $341 more. We reviewed our records and determined that they had been overpaid. The hospital disagreed and sent us to collections.
We fought back. Steve contacted the Department of Health Services. He was told to bypass the hospital billing department and go directly to the Chief Financial Officer, explain our story and offer a discounted settlement.
Steve politely, but firmly, approached the CFO, explained our experience, bad business practices, unreturned calls and unacceptable lapse in medical billing. By working up the ladder, we not only received a zero balance, but an apology from the CFO. Yes, we asked for a written confirmation of the zero balance.
Steve and Annette Economides are authors of America's Cheapest Family Gets You Right On the Money (A New York Times Best Seller) published by Random House 2007. They also publish the HomeEconomiser newsletter 6 times each year. For more info and lots of free money saving ideas, visit www.AmericasCheapestFamily.com
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