I'm giving our insurance co. credit for all of my grey hairs. Wonder if I can claim getting my hair colored as a medical expense? Seriously though, dealing with health insurance companies can cause you to lose your mind....but then you'd be stuck having to deal with them to pay for the treatment of your mind. Unfortunately we've dealt with them way too much, but through it all I've learned valuable information that hopefully can help save you time...and your mind.
IT'S NOT PERSONAL...IT'S BUSINESS
First things first...remember that your health insurance company is a business. They are out to make money. Like all successful companies, they make a lot of it. Millions of dollars in premiums are paid each year to health insurance companies who make money by spending as little of the money you give them as legally possible. .
HAVE YOUR DUCKS IN A ROW
It's always best to have everything in writing. If you have a contact email...use that instead of calling. Although all calls are recorded, you will never get the same level of attention if it's not in writing. Having a paper trail is one of the best defenses you have if things go awry. If you do need to call make sure you are prepared. Here are a few tricks I've found helpful.
KILL THEM WITH KINDNESS
After you listen to a hour of smooth jazz, and press 40 prompts you finally get a live human to talk to. I know this may sound totally contradictory but although the random human who picked up your line works for your health insurance company and is doing their job....they are, in fact, human. It is not their fault your claim was denied, or whatever the reasoning it is for your call. Ever hear the phrase you have to give respect to get it? Yeah, unfortunately this applies to insurance agents too. That person is your only link to getting what you need. You will hit a brick wall if you call yelling and screaming. So what can you do?
NO SAY.... NO PAY
We actually had this situation come up 2ce with Emma last year. She had a muscle biopsy done that was ordered by our Neurologist to have some genetics testing done. The Anesthesiologist our hospital used wasn't in-network with our insurance company nor was the lab that did the testing. Our insurance was billing under out-of-network. This is a big NO, NO and your insurance knows it. If you chose a doctor etc that's out-of-network, then that's on you. You are not legally responsible for anything you didn't have a say in. They will try to pull one over on you, and unfortunately some people just pay up.
MAKE SURE IT MATCHES
Before you pay a dime of your bill make sure you have your EOB that goes with that bill. Make sure the bill from the provider and your patient responsibility on your EOB matches. Especially if you're dealing with thousands upon thousands of dollars of claims...things get messed up. Providers like to jump the gun before they get a response from your insurance co. Sometimes they guess you have a deductible that hasn't been met, or a co-pay. If your EOB has anything that shows it's a non-covered service...ask about it. Sometimes coding is wrong, or other human error. They can always resubmit the claim.
APPEAL...APPEAL AND APPEAL AGAIN
Your doctor orders a procedure, test, treatment, etc. and you get a denial form letter in the mail from your health insurance company with the typical denial jargon. According to the denial letter the medical expert that is hired by your insurance company that denied your claim found your claim not be medically necessary, or the test is experimental, diagnostic, or the test won't change your course of treatment. Here's some things that you can do to try and get what you need approved by your insurance or your doctor wouldn't have ordered it in the first place.
Most importantly, be persistent. You are your, and your child's best advocate. It seems unfair that with everything you are going through, that the added stress of health insurance is another burden to carry. Don't let it break your spirit. Persistence does pay off. Use the stress you feel against your health insurance company as fuel to fire your determination to fight for what is best for your health and your child's. Hang in there...I'm fighting along with you.
Welcome to my daughter Emma's medical journey blog. Read updates on Emma and helpful tips for researching and coping with a child with an unspecified, rare genetic disease living in chronic pain. Click on the ABOUT tab to see how her journey started.