Okay, here is another healthcare landmine, that is usually avoidable. I am making it my mission to help as many people as possible avoid the frustrations that I am seeing in my office. (When my clients have trouble, I am who they call.)
First, it is important to understand that when healthcare providers order outpatient tests or medical procedures that do not require precertification, that does not mean that your health insurance will cover them. It doesn't matter if they covered your friends' or coworkers'. Many tests and procedures require that the patient meet specific guidelines before an insurance company will pay for them. Most insurance policies utilize contracted provider networks. Contracted providers have access to the guidelines that must be met before a test or procedure will be covered by an insurer.
Unfortunately, test and procedures are too frequently done without regard for these guidelines leaving the patient responsible for the bill!
Most patients don’t pay much attention to all the documents they sign before receiving medical services. One of those documents includes a statement that goes something like, “If the insurance company refuses to pay, I will pay.” Notice there is nothing in that statement about the provider having any responsibility at all. To be fair, some providers are better than others about looking out for their patients, and the mountain of hoops that providers must jump through to comply with insurance and Medicare guidelines can be pretty staggering. It is unreasonable to expect doctors and their staffs to be on top of each insurance requirements. Informed and engaged patients can save themselves a lot of time, frustration, and money.
So what can you do?
Ask about each test and
procedure that is being advised...
"Will it be covered by my insurance?"
If the staff doesn’t know, ask them to find out. If they tell you a test or procedure has been pre-authorized, ask by whom and when, and write that information down. If they tell you a test or procedure doesn’t require pre-authorization, ask if the test or procedure meets the criteria that your insurance company requires in order to pay for it. If they confirm that it does, write down their name, date, time, thank them and let them know you have made a record in case there is any problem. If whomever you’re speaking with hems and haws about what they are telling you, beware. Sometimes a staff member just doesn’t want to spend the time – and yes, it’s can be pretty time consuming. Be kind and understand that knowing these things upfront requires patience, but if you don’t want to end up paying the bill, this is pretty much what you need to do. Of course, when you need immediate emergent care, you can't do all this, but don't rush to the ER if you can go somewhere else either.
Comments