You open your mail to find a letter from your health insurance company. Their correspondence always confuses you, so you set it aside and move on to another task. The letter sits there for days, unread. Then, you receive a call from your doctor's office, telling you your insurance company is requesting information from you before they will pay for your services. What?! They've not asked for information from me! And then you remember the letter you opened and set aside...
In my ten plus years as a patient account representative and insurance clerk for a multi-specialty physician medical clinic, I see this scenario over and over. Today I had this very same incident happen to one of my patients. Many do not understand the confusing world of health insurance, and to some, ignorance is bliss. However, such ignorance can lead to many problems in the future at your doctor's office, where all of a sudden, a $1,000.00 bill for services is owed by YOU.
Here's what can happen: You have nagging wrist pain that has been bothering you on and off over the past six months. Finally, after many twinges and annoyed looks from your significant other, you finally decide to see your doctor. He examines your hand, orders x-rays, additional testing, etc, in order to make a diagnosis. You leave his office that day with a million other things on your mind than whether or not your health insurance will pick up those charges.
Then, a week or so later, you receive that fateful letter in the mail that you cast aside. Then, the call from your doctor's office saying your claim has been denied because of additional information requested from the insured. When you get home to read said letter, titled "Accident/Injury Questionnaire", you learn they are wanting to know how you injured your wrist. They have enclosed a long form that you need to complete, asking everything from where it hurts to who has treated you for it in the past. Confusing? Yes indeed! Why? Because if someone else is liable, your health insurance company may not pay. However, it's very important to complete that form and mail it back to your insurance. Most medical offices then send you the bill, because there is nothing they can do to make you turn in this information.
So, you send in the form, and voila! Bill paid! Now, remember this important lesson, and don't cast aside health insurance letters again! But remember, there are other reasons you may receive a letter from them, wanting information. Other health insurance information, for example, your spouse has coverage and so do you. This is called Coordination of Benefits information or COB. In the case of families with two insurance carriers, many health insurance companies need the information so they know who is primary, and who is secondary, so they do not pay out of turn. There's also the birthday rule that can take effect, meaning whoever has the first birthday of the year will be the primary carrier for the child. Confusing? Oh yes, but important. Many times a quick phone call to your health insurances will straighten that mess out. Also, you may receive a letter asking if your twenty-one year old child is enrolled full-time in college. Many health insurance companies will not insure children after a certain age if they are no longer enrolled in school.
Many times I see people frustrated to the point of anger because of their health insurance not paying their claims. But, with some simple steps, starting with a call to them if necessary, most problems can be worked out fairly easily. Just remember, knowledge is power in the case of health insurance. The more you know how it works, the better, and less confused you will be. Check out your health insurance carrier on the web, and get to know how their site works. The larger companies have enormous websites that offer help in understanding your benefits. Many companies allow you check the status of claims online. This is a great tool that is underutilized.
Next up, deciphering your insurance explanation of benefits, or EOB, and terms that go along with it!