Protect Your Healthcare Insurance

by Shaunna Privratsky


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You pay hundreds of dollars a year for healthcare insurance. It brings peace of mind, knowing that you are covered. Then an illness or a medical emergency strikes. You concentrate on recovery, unconcerned about your healthcare insurance. Until you receive notice that your claim was denied. The emotional outrage is almost enough to put you back in the hospital.

Before you blow your top, consider these steps to safeguard your healthcare insurance. First off, read the fine print of your policy. It will also give you the steps to take when your claim is denied. Knowledge is crucial, so arm yourself before you contact the insurance company.

Make it easy for your doctors to get involved. Have them state your illness or condition, any steps and procedures taken, and why they were necessary. Provide addressed, stamped envelopes and a letter outlining what you require.

When you contact the company, try to keep it businesslike. Although it is very emotional for you, it is a business matter to them. Yelling and screaming will not help your appeal. Follow up phone calls with a certified letter or email. Make sure you note the names of all the people you talk to for later verification.

File an appeal. Attach any documents that bolster your case, including test results, lab reports and a letter from your doctor explaining why the treatment or surgery was necessary. Most denied claims have the steps to take right on the document, so follow the steps carefully. Make copies of everything and keep them handy for future reference.

Make sure you file the appeal within the specified time frame. Most plans require that you challenge the denial within 60 days. The two biggest mistakes patients make is not meeting deadlines and not giving enough background material to justify coverage of the claim.

Whether your appeal is approved or denied, you can take steps to make sure it never happens again. When filling out health questionnaires, don't go overboard. Giving out too much information can lead to claims of pre-existing conditions. For example, if you make a big deal out of breaking several bones in childhood, the insurance adjusters may conclude that you are prone to osteoporosis.

Whenever possible, get pre-approved for major procedures. This can be as quick as a phone call, but make sure you follow up with a letter, so that you have proof in case you need it. A letter from your doctor explaining everything is invaluable and can tip the scales in your favor if coverage of the procedure is at all questionable. Make several copies as insurance.

Follow all of the rules, even if they seem ridiculous. Make sure your doctor and chosen medical facility is accepted. If your plan is a Health Maintenance Organization, or an HMO, you have to use the participating doctors and hospitals. With a Preferred Provider Organization, or a PPO, which allows you to go outside the preferred provider network, but your coverage may be substantially reduced. Again, a simple phone call can verify this, but get it in writing.

Go over the fine print again, especially if you are worried your illness or treatment might not be covered. If you are unclear about anything, contact your insurance company. Again, note the contact person's name, date and follow up with a letter or e-mail to protect your claim.

Finally, if you are not getting anywhere with your company, check your state's laws on fair insurance practices. They can sometimes override an unfair decision or facilitate in an especially difficult case.

You can also demand an independent review. Forty-three states have enacted a Patient's Bill of Rights, which includes the review. It is worth the effort, since over 50% of patients prevail in the challenges.

If you are not happy with your current insurance provider, shop around. There are many companies that are dedicated to helping protect people with healthcare insurance. If it is offered through your job, look into all the options. You may opt for broader coverage with a larger premium, or a more limited policy with less out of pocket expense but a higher deductible.

You might be able to increase your coverage or change it to better suit your needs. If you have a choice, choose the plan that gives you the most peace of mind and will protect your health without sending your family to the poorhouse.

You might think that a little health insurance coverage is better than none at all, but weigh the facts before making a choice. Many limited benefit plans have very low maximum payouts. They may only allow four or five doctor visits a year and do not cover emergency, surgery or hospital stays. In this case, you might be better off saving your premiums in the bank and paying for medical services out of pocket. Most facilities will offer at least a 10% discount to patients without insurance, or will work with you on a payment plan.

With the cost of any medical care skyrocketing, some sort of healthcare insurance or plan is a necessity. Going without it can lead to financial ruin. Learn to use it to your advantage and it will be there when you need it. Today's savvy consumers must learn to not only protect their health, but also their health insurance.


Shaunna Privratsky is an expert in personal finance. Between writing, reading and gardening, she is always on the lookout for bargains. Please sign up for the free newsletters at The Discount Diva. You can also visit Shaunna on Google+.

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