Health insurance is a struggle for most people. Even if you’re one of the fortunate people whose employer pays all or most of your premium, it’s a headache. If you’re buying insurance on your own or going without it, it’s a full-blown migraine.
Why should something that costs so much to protect you cause many problems?
The answer is that insurance companies make it complicated. Policy language is complex, and coverage is a game of hit or miss. Gone are the days when health insurance covered the cost of whatever care a policyholder needed.
Your insurance is necessary for major medical care, but you might be able to relieve the routine stress. If you’re weary of fighting your health insurer to access coverage, you might want to check out some alternatives. Here’s how you can make insurance less of a headache.
You might have used the same birth control method or migraine medicine for years. Nothing has changed – except the hassle you face when refilling your prescription. It just shouldn’t be that hard.
Skip trying to get in to see your doctor and make monthly trips to the pharmacy. Instead, set up a birth control subscription with an online provider. Besides the hassle, you’re allowing your health plan to deny a claim somewhere along the way.
Online providers will submit charges to your health insurance plan if you have it. Regardless, the cost of a subscription with many providers is surprisingly affordable. Pay as you go, and your prescription shows up discreetly at your door every month.
Magazines and meal kits aren’t the only items you can subscribe to. You can set up your birth control and even some other medications. Then you can essentially forget about them. Insurance need not apply.
Recent federal rules require health insurers to disclose what they pay providers and hospitals to publish service costs. These measures are designed to inform healthcare consumers and allow them to compare shops.
But now, companies build networks of providers willing to discount fees for patients paying out of pocket. You can reap the benefits of everything from routine office visits to diagnostics like MRIs and cardiac stress tests. It’s transparency at its best, and taking advantage of it may save you money and headaches.
You don’t have to join anything. Just find a provider of the service you need that participates in one of these online healthcare marketplaces. Then find out what they charge if you skip having them submit charges to your health insurance plan.
What you pay out of pocket won’t apply to your plan’s deductible if you take this route. But the cost savings and avoiding getting your insurance plan involved may be well worth it.
Healthcare providers want to get paid for the services they render. It’s their job to obtain approval, submit charges to insurers, and collect payment from them. No one is better at breaking down your plan’s barriers than their medical billing staff.
The key to this is early intervention. It would be best to ask your doctor or another healthcare provider for pre-approval. Once you receive the services, you’re on the hook for the bill regardless of whether your plan pays.
The medical billing pros assign the proper medical coding, which insurers rely on to check coverage. They submit those codes and wait for the plan to approve or deny coverage. Your provider lets you know exactly what is and isn’t covered and what you’ll need to pay out of pocket.
As the saying goes, “forewarned is forearmed.” And in this case, you wait for the information about coverage and costs. Let the medical billing folk deal with the headaches.
Oh, if only understanding what your health plan does and doesn’t cover were easy. Unfortunately, it’s not. As a general rule, make no assumptions, or you could end up with an unexpected bill you’re responsible for paying.
Ignorance is no defense in this case. It would be best if you read your policy, cover to cover, but you may not understand it. Plans are required to provide a summary of benefits and coverage in plain speech, although some are still tough to understand.
If your employer provides your plan, discuss your coverage with whoever is responsible for benefits, probably human resources. Otherwise, set aside time and call the insurance plan’s customer service representatives. They should be able to walk you through plan coverage and answer your questions.
It’s stressful when you need to access care but aren’t sure if your insurance plan covers the services or provider. Familiarity with your project and how to appeal denials is one way to reduce that stress. Plus, you might avoid some unpleasant, headache-spurring surprises later.
The insurance designed to reduce or eliminate the cost of medical treatment often causes more pain than the complaint itself. That irony is lost on few but a reality for most people with insurance plans. Don’t be at the mercy of your health insurance. Instead, take a few steps to get the care you need. You can leave the headaches in the same drawer where you’ve stashed your policy.