How To Avoid Problems With Your Medical Insurance Claims

√-How to avoid problems with your medical insurance claims

I recently had a bunch of medical work done and realized that I was completely unprepared to deal with a medical insurance claim. I’ve grown complacent, since I’m rarely sick.

Ironically enough I work in the medical field, so you would think I would be prepared.

Instead I made a couple of very rookie mistakes.

  1. I had my old health insurance cards – The first time I went to the office, I whipped out my card, paid my co-pay and thought I was good. One my second time, they mentioned that my medical insurance had been cancelled. I know that the funds had been deducted from my husbands payroll, so I was pretty sure I was fine. Fortunately with a quick call to my husband I had a copy of the new cards.
  2. I didn’t update all of the services associated with the doctor’s office. Like the medical novice I am, I just assumed that my doctor’s office would update the lab company with the new information I presented.
  3. I ignored the first few medical statements from the lab company assuming there was an error since I had given the updated information to my doctor’s office.
  4. I didn’t double check. Once I finally realized there was an issue – after receiving 3 medical bills, I called the lab company and provided them with the correct information. Something must have happened on their end because I got another bill 3-4 weeks later. This time, I contacted my health insurance company who told me they had never received a claim.

This morning I just contacted the lab company again with the updated information and hopefully have everything resolved.

The crazy thing is, this whole thing could have been prevented if I had just had the correct medical card in my wallet.

Instead, I spent 2-3 hours tracking down the correct card and then dealing with the various medical offices and contacting my insurance company.

What I also didn’t mention is that I’m HR Director for our company. It is a small company, so it is more of a glorified title then anything, but I am the one responsible for choosing and implementing our health insurance.

I’ve had to help various employees with similar issues and even though I’m smiling on the outside, inside am wondering how they could be so clueless about their medical care.

I’m feeling a bit hypocritical now – hopefully I’ve learned my lesson!

So just a few helpful hints based on my personal experiences and experiences with co-workers.

  1. Always keep a copy of your medical insurance card with you. I also recommend taking a picture of your card and emailing a copy to yourself.
  2. Carefully review your plans medical summary plan description and actual plan documentation. Know what is covered and what needs to be pre-approved.
  3. Don’t be afraid to call your health insurance provider and ask questions. Always take notes of the conversation and who you spoke with. Remember that just because an agent tells you something doesn’t meant that they are always right. If you are hesitant about what they tell you, call back and speak to another agent.
  4. Remember that all conversations with the insurance company are recorded. This can be a huge benefit to you if you have asked the right questions.
  5. BE POLITE – You will always get better advice and services from your doctor’s office and medical insurance company when you treat the employees with respect. It is rarely that specific person’s fault you are having issues, so taking it out on them is only going to make them more resistant to helping you.
  6. Choose your plan wisely. I’ve written a post on PPO vs. HSA plans. If you have the option between the two I recommend reading it.
  7. If you have the option of an HSA plan make sure you are contributing to your HSA account.
  8. Always follow up promptly with any medical bills and statements you receive. Most insurance companies have a 3-6 month billing deadline. If you have not provided the correct information to the doctor’s office in a timely manner, they can deny the charge which then rolls back to you.
  9. Double check your bills and statements. I work regularly with our billing company and as hard as they try mistakes are made. They overbill, they under-bill, personal information and insurance information is entered incorrectly. The emergency department we bill for saw over 90,000 patients last year. Mistakes will be made. Most people catch the large errors, but small $20 charges can add up as well. Refer back to #3. If you have questions call.
  10. Don’t assume that the insurance company and doctor’s office have your best interest at heart. They are a business and will make mistakes. They aren’t done maliciously, but mistakes happen.
  11. Protect your personal information wherever possible. Multiple people have access to this information whenever you see a medical provider. If your insurance company is still using your social security number as an identifier, I highly recommend contracting them and requesting a new identifying number.

This list is not inclusive and I have a feeling I’ll be adding to it over the next couple of weeks. Please comment below if you think of another helpful hint.

The most important thing to remember about medical care is that ultimately the buck stops with you. Your medical care is your responsibility. Know your policy and know your rights. Take the time to protect yourself and your family – don’t make my mistakes.


Receive Our Newsletter

Subscribe To Get Bi-Monthly Content On Personal Finance, Parenting and Successful Living

Powered by ConvertKit