Every other day we hear some news about Healthcare Bill. Democrats are trying hard to survive in the next term by selling this bill idea. The irony is, situation of people having insurance is worse than those without insurance, because their premium covers charges for uninsured ones. It becomes worse when you cannot get insurance with pre-existing conditions and even if you do not use much of the insurance, premium goes higher every year.
Survey says that there are about 47 million Americans who do not have any kind of insurance. There are definitely some in this bunch who can afford it but still would not spend the money. I personally know few of them who live in houses and always shop branded stuff, but are not willing to buy insurance.
Anyway, here I want to share incidents that happened to me in the last few months. Problem does not end if you have a perfect insurance plan, actually problem begins here!!
It has been few months since we moved to this new place. As we moved here, we had to look for a new doctor. We both set up an appointment with PCP and went for a complete blood check. Then recently, HE started suffering from severe pain in lower abdominal. He had to go for blood check and CT scan. Result? Several visits to doctors, labs, emergency and urgent care. And now almost every other day we receive a mail from lab, hospital or insurance company. Sometimes bill and then other times explanation of benefits. Though we have a very good insurance plan, we get panic looking at the bill. Almost every day I call the concerned person to resolve the issue. Luckily, nine out of ten times, it’s somebody’s mistake and we do not have to pay the bill. But the question is, why is this system so complicated? If you ask the same questions to different representatives from your insurance company, I bet every time you will get different answer. Even though you would not be able to understand much since they explain you in a very ambiguous language. I literally searched online about lot of things so now at least I am comfortable understanding the bill and talking to insurance company. But here are tips, useful for someone new to this system
• Before seeing any doctor, make sure you have the proper coverage. Sometimes at the time of renewal, though it is continuous coverage, it takes a while to get the new cards.
• Check with your insurance company if you need to assign PCP and whether referral is required to visit a specialist
• If you are a new patient, make sure doctor accepts your insurance plan
• It is preferred to ask for receipt when you pay your copay
• If doctor advises you to go for lab work, they tend to send you to the labs they have contract with. Make sure that this lab is also affiliated with your insurance company. Otherwise it will be considered out-network visit and you will end up paying deductible
• If physician advises you to go for certain kind of test (Like CAT, MRI) or surgery, check with your insurance company if pre-certification is required. If so, mention this to concerned doctor/hospital and ensure that they notify insurance company.
• Some states have facility of urgent care. They bill like an office visit only, but still being urgent care, you quickly get an appointment. Check if you have one in your area so you can reduce number of visits to emergency.
• If you happen to go for in-patient/out-patient surgery, call your insurance company in advance to understand your coverage
• When you call insurance company to understand coinsurance and deductible, always clarify again with exemplary figures.
• If you talk to hospital/lab/insurance about any bill and if they ask to disregard it (since it was a mistake), make sure to ask for reference number. If they cannot provide reference number at least ask for the name of the person and badge id.
• If you need to go for emergency and if problem is not very serious, avoid calling ambulance. Drive yourself or let somebody take you to the emergency walk-in
• When you receive any bill, check your account with insurance company whether they received similar claim. If they have not received any claim, which means doctor/lab/hospital did not send the claim or did not send it at the right place. Call the sender and confirm if they have correct insurance details. Also confirm the address to send the claim, which is usually available on ID card.
Hope this helps!
Survey says that there are about 47 million Americans who do not have any kind of insurance. There are definitely some in this bunch who can afford it but still would not spend the money. I personally know few of them who live in houses and always shop branded stuff, but are not willing to buy insurance.
Anyway, here I want to share incidents that happened to me in the last few months. Problem does not end if you have a perfect insurance plan, actually problem begins here!!
It has been few months since we moved to this new place. As we moved here, we had to look for a new doctor. We both set up an appointment with PCP and went for a complete blood check. Then recently, HE started suffering from severe pain in lower abdominal. He had to go for blood check and CT scan. Result? Several visits to doctors, labs, emergency and urgent care. And now almost every other day we receive a mail from lab, hospital or insurance company. Sometimes bill and then other times explanation of benefits. Though we have a very good insurance plan, we get panic looking at the bill. Almost every day I call the concerned person to resolve the issue. Luckily, nine out of ten times, it’s somebody’s mistake and we do not have to pay the bill. But the question is, why is this system so complicated? If you ask the same questions to different representatives from your insurance company, I bet every time you will get different answer. Even though you would not be able to understand much since they explain you in a very ambiguous language. I literally searched online about lot of things so now at least I am comfortable understanding the bill and talking to insurance company. But here are tips, useful for someone new to this system
• Before seeing any doctor, make sure you have the proper coverage. Sometimes at the time of renewal, though it is continuous coverage, it takes a while to get the new cards.
• Check with your insurance company if you need to assign PCP and whether referral is required to visit a specialist
• If you are a new patient, make sure doctor accepts your insurance plan
• It is preferred to ask for receipt when you pay your copay
• If doctor advises you to go for lab work, they tend to send you to the labs they have contract with. Make sure that this lab is also affiliated with your insurance company. Otherwise it will be considered out-network visit and you will end up paying deductible
• If physician advises you to go for certain kind of test (Like CAT, MRI) or surgery, check with your insurance company if pre-certification is required. If so, mention this to concerned doctor/hospital and ensure that they notify insurance company.
• Some states have facility of urgent care. They bill like an office visit only, but still being urgent care, you quickly get an appointment. Check if you have one in your area so you can reduce number of visits to emergency.
• If you happen to go for in-patient/out-patient surgery, call your insurance company in advance to understand your coverage
• When you call insurance company to understand coinsurance and deductible, always clarify again with exemplary figures.
• If you talk to hospital/lab/insurance about any bill and if they ask to disregard it (since it was a mistake), make sure to ask for reference number. If they cannot provide reference number at least ask for the name of the person and badge id.
• If you need to go for emergency and if problem is not very serious, avoid calling ambulance. Drive yourself or let somebody take you to the emergency walk-in
• When you receive any bill, check your account with insurance company whether they received similar claim. If they have not received any claim, which means doctor/lab/hospital did not send the claim or did not send it at the right place. Call the sender and confirm if they have correct insurance details. Also confirm the address to send the claim, which is usually available on ID card.
Hope this helps!
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