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Are You Having Difficulties With Your Health Insurance Plan Coverage?

Feb 14, 2008
If you have health care insurance I have news for you: the health insurance company is concerned and worried most not about your health, but their pocketbook and charts and graphs with nice color and upward lines. Be glad that you are not in Canada with socialized medicine. There the doctor's responsibility is to faceless, vanilla bearcats not to you or anyone else. At least you have the ultimate threat: to take your health insurance coverage business elsewhere.

What can you do to ensure that you get the best health care coverage - not only for your money but first and foremost the health of your family? First of all if you are hospitalized and treated do your best to stay within the system. Leaving your own network costs you extra. Watch out especially for in hospital "out of network doctors" such as radiologists or anesthesiologists. Speak up and ask ahead of time.

Always check into the coverage of your plan. There may be useful upgrades at little or almost no cost, which are worthwhile in terms of coverage of benefits. In addition your state may mandate that certain medical procedures or tests (many of them expensive) must be covered by any firm wishing to do business in the state. The glossy brochures that you will have been given by the insurance company are printed by head office for the country as whole and may not indicate your total coverage and benefits. If in doubt ask. If you do not get a complete and comprehensive answer phone the state government authority.

It goes without saying that the squeaky wheel gets the grease. If you are really not getting anywhere within a more than reasonable period of time - time to draw attention to yourself by notching up your symptoms. The internet is a wonderful source of information easily accessible. Just don't be abusive and don't cry wolf.

Interestingly enough in all legal questions the first rule of any lawyer is "Don't sign anything". The same can be said here in dealing with forms that you do not understand or you are not comfortable with. Remember the insurer has to provide coverage in the meantime. Not to say that some forms are essential for medical procedures. However if you are not sure, do not sign, delay. You can always take the forms for legal advice just to make sure.

If you do have problems or concerns along the way it is best to communicate these via writing - email, fax, and letter. The key thing is that the documentation is in writing. The health insurer cannot wriggle out of it saying either you misunderstood a phone call or this is not policy. Written documentation is standard fare. In cases of disagreement the documentation stands alone - it's a third party. The argument and challenge is against their written response, not against you personally. It goes without saying, if you are not sure what the response means, ask again, or clarify by return written communication. Always place a date on any documentation of well. It provides additional and further proof of times and events.

Lastly remember the pinnacle of the health care team is the doctor. In our society the word (or signature of a licensed trained doctor) takes inordinate weight. Use the doctor and this power for your good purpose. Specialists carry even more weight. A medical specialist's signature on a request or report will jump across the room to the health insurance plan officials. As they say "Go with the flow".

In the end it's all about your health. If you cannot do a little extra work and effort for you or your families health who will?
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