7 Health Insurance Secrets You Should Know

Health insurance companies like to save money, and they have secret ways of doing it. Here’s how to win out when they don’t want to pay:

1) Out-of-network providers. If you purposely use an out-of-network doctor, you’re probably going to have to pay. But if you had no choice, such as when the hospital chooses the anesthesiologist, you may fall under the “I had no say, so I don’t have to pay” rule, in which the insurer most often has to pony up. You may also find that your insurer is using an out-of-date network provider list – you can often find a current list for your network posted on the Internet. Check it out and inform your insurer if your doctor is indeed on the list.

2) Your insurer says you’re not covered for certain benefits, such as infertility coverage. Some states require coverage for some benefits, but not others. The best way to find out for sure is to check with your state insurance commissioner.

3) Your company isn’t paying, but is requesting releases to view your medical history. They may be fishing – that is, they may be trying to catch you out on an omission when you first applied for insurance with them. Stall, and don’t sign. Most review processes last 60 to 90 days, and after that time they pay.

4) Your insurer says you received treatment that’s not covered, such as massage sessions for lower back pain. Ask your doctor to tell the insurer he’s going to file a complaint with the state medical board. But don’t try to file a complaint yourself, since you may do more to hurt your case than help it.

5) If you think you need a test, do some research on the Internet and talk up your symptoms with your doctor. Most insurers pay when a patient has physical complaints doctors can’t ignore.

6) Get drugs cheaper. Buy generics. If they don’t make them, try mail ordering drugs, which is often less expensive. When all else fails, if you’re using a medicine long-term, such as for allergies, try to get your physician to write a prescription for several months supply, thereby avoiding extra co-pays.

7) If your insurer absolutely refuses to cover an illness or operation, try a patient advocate. Advocates make their money by helping you, and usually request only a small retainer fee up front. To find one, contact the Patient Advocate Foundation, or check with a medical association connected with a particular condition, such as the Multiple Myeloma Association.