Let's look at an example to illustrate this point. You go to your doctor for a checkup and he wants to run some blood tests on you. Ok, that makes sense, you have not had a blood test run in a few years, so let him do it. Several weeks later, you get a statement in the mail from your health insurance company saying that the total cost of the blood test procedure, including the drawing of the blood, the tests, and the analysis of the results cost $500.
Next you note that the health insurance company is trying to make you feel better by noting that they covered $300 of that cost, leaving you with a balance of $200 to be paid to the doctor or the clinic that did the blood test work. Wait a minute, where in your health care insurance policy does it say that for this type of procedure, they are only going to cover 60% of the cost? Chances are that you will find no such statement if you go over every word of your policy with a fine tooth comb.
What happens with far too many people is that they simply sigh and write out a check to the doctor's office for that $200 and don't think about it again. Except they WILL think about it again the next time the doctor suggests a blood test, when they will decline the doctor's suggestion, and perhaps miss something important that could be a sign of an oncoming serious illness.
What you should do is contact your health insurance company and request a written explanation for why they are only covering 60% of this medical procedure. They owe you an explanation since you are a policy holder with them. Request that the claim be reviewed again by the health insurance company since you do not agree at all with the outcome they have determined. They are obligated to do this for you.
The outcome of such a dispute is going to be one of several. It may make no difference at all. Or the health insurance company may strike a deal with the doctor's office or clinic that the charge should have been only $350 instead of $500, and the insurance company still pays $300 of it, leaving you with only a $50 balance. Such disputes are requested every day, so it should come as no surprise that you are disputing it with them.
If the health insurance company holds a solid line on the claim and refuses to adjust it, it may be time to be looking for a different health insurance company for you and your family. This industry is far too competitive to allow yourself to be stepped on like this, and you can vote with your wallet by going to a different company. You have hundreds of options to choose from.
But if you switch companies, make sure that you understand what is covered and how much of it is covered with the new company. Since you already have health insurance coverage, you can take your time and make sure of all the details before you make the switch. You may also want to keep your existing insurance and supplement it with secondary coverage, which starts to take effect where the first one leaves off in terms of the total balance due out of your pocket.
0 komentarze:
Post a Comment