What Health Insurance Companies Don’t Want You to Know

Many health insurance companies are like boxes full of secrets. They are good at tricking members to save money. For example, you have surgical operation, and after few weeks you receive a bill stating that you sought an out-of-network anesthesiologist.

You think it’s crazy since you weren’t the one who chose the specialist. And you firmly believe that you shouldn’t pay extra. But your health insurance company sent you the bill anyway, hopeful that you wouldn’t notice. According to Healthcare Advocates president Kevin Flynn, scuffling against this kind of deception – and winning – is much easier than you think. Here are four ways to get that health coverage you really deserve.

Don’t pay if you don’t have direct control

Purposely seeing an out-of-network health specialist will cost you. But when you have a medical procedure, the hospital selects the anesthesiologist.

Flynn says that if you get that irritating "out-of-network" bill, write a strongly worded letter to the insurer stating that you were not consulted about the choice of the anesthesiologist and, therefore, won’t pay the extra cost. Flynn says that you’re not liable if you don’t have a say. This usually works, but not many consumers don’t have the knowledge about it.

Get everything in writing

Sure, it may seem very inconvenient, but the traditional letter is a good way to communicate with health insurers. Washington, D.C.-based attorney Rhonda Orin says that you must not do anything over the phone as "It takes forever and when you’re done there’s no record of it, so it didn’t happen". To whom should you address the letter?

It is recommended that you follow your health plan’s appeal process for letters. Also, you have to send copies to the state insurance commissioner. It is important that you keep copies of all the mails you’ve sent to the insurance company and every letter they’ve sent back. This will work in favor of you when your insurer tells you that they never said they would cover the surgery or test. You can always say, "But I have everything right here in writing."

Doctors can be your arsenals

You have lower-back pain and the doctor orders four massage sessions. But your health insurer says they won’t pay for the sessions. Go to your doctor and ask for some help. He or she can tell the insurer that he or she will bring the matter to the board that regulates health insurance in your state.

James Moss, a retired Kentucky surgeon says that health insurance companies may not be scared of you, but they respect the board. Another alternative is to say that you’re going to call the state Medicare office and/or your congressman to file a formal complaint.

You may be qualified for more benefits

You could be qualified for more health coverage than what your insurer is telling you about. This depends on your state. For example, health insurance companies operating in Maryland need to pay for expensive infertility coverage. But health plans in Virginia don’t. You can check the consumer group Families USA for information about state rules. Another option is to contact the insurance commissioner of our state.