Fighting Insurance Confusion

Since January is when a lot of us are dealing with insurance policies, I thought I'd share a little tip I've picked up.

We had a delightful piece of mail come in a couple of weeks ago. I went to the doctor last month and before scheduling the appointment, I asked if they accepted my new insurance. They said they did. After the first appointment, they called the insurance to ask if they covered the procedure I had done. I was told it would be covered 100%. I had it done and all was well until I got the Explanation of Benefits stating that they weren't paying a penny because it wasn't in network. They said that the nurse practitioner that performed the procedure was in network, but the office wasn't. Unfortunately, they had filed the claim under the office. The insurance company had completely drained my health fund and said I still owed $600. I called the insurance company and filed an appeal. I'm still waiting to find out if I win. If I win, the amount in my health fund gets rolled over to my plan this year, so this issue is worth $1100.

We got a new insurance plan through my employer (Our 3rd insurance company within 6 months. Woohoo...), so I was worried about having a similar experience. Most of my coworkers have found that their doctor's aren't in network (My boss has gone to the same doctor for 22 years and now has to find someone new) or that all of the doctors at the office except one are in network. It is very frustrating and overwhelming. I went to the website to search for my providers as I usually do when I noticed a disclaimer stating that just because a provider was listed was no guarantee that they were in network. Wait, what?

I did my search but wanted to get good proof in case of dispute. I found a link where I could live chat with someone from the insurance company. I explicitly asked if the doctor's office (with address and phone number) and each of our primary care doctors were in network. They explicitly told me they were. I asked about the hospitals that were in network and verified the ones that we would be most likely to use. They explicitly said they were. There was a button at the bottom that let me download a transcript of the chat with the date, time and name of the rep. I save these in a folder and rename with a description: "Primary Care", "Dr. xxx", etc.

Before I made another doctor's appointment, I asked again about the office and the doctor. I also asked explicitly for information about what my plan covers and how it is processed since some plans have limits on numbers of treatments per year, or will charge a different coinsurance rate.

If I get billed improperly from now on, I will have a lot more supporting evidence in my appeal. It only takes a few minutes once you know where to look. You can even bookmark the page to live chat.  If taking five minutes here and there saves me from another $1100 mistake, it will be a great hourly rate.

Good luck out there!