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Understanding Your Health Insurance Policy - Part 2 of a 3 part series

Now that you are familar with the basics of the policy, it is important to check with your health insurance company if you are planning an upcoming hospital admission or procedure.  By checking with your health insurance carrier, you can make sure you cover all the bases, and lessen the chances of any coverage issues or precertification problems.  Know the benefits, know the plan rules, and follow those rules.  Again, staying within the network --as most plans have a preferred network of providers-- is the best way to minimize your out-of-pocket (deductible and co-insurance) expenses.  

Going to a network doctor and hospital also means they will file the claim for you.  The payment will go to the doctor and hospital.  It is best to wait for your explanation of benefits from the insurance company, before making any payment to a doctor or hospital.  That way, you can make sure you pay exactly what you owe, rather than overpaying and have to request (and wait for) a refund.

Once you receive the explanation of benefits from the insurance company, match this information with the bill received from provider of service.  The 'date of service' and 'total charge' are the key pieces of information needed to match the provider bills to the explanation of benefits from the insurance company. 

If you are unsure of how to interpret the information on the explanation of benefits, call the insurance company and have a representative go over it with you.  After you do this a couple of times, it will make sense and you will be  able to easily understand the jargon, and to also know when something doesn't make sense.  If it doesn't make sense to you, call and question the insurance company  until you a satisfactory answer. 

Remember that you always have the right to appeal a claim in writing, if initial efforts to resolve issues with a simple phone call are not successful.   More on 'how to write an appeal' in Part 3 of this series.

 

 

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