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Don't Forget You Annual Check-Up
Conditions do not manifest themselves in our bodies overnight, it takes time. By going to the doctor and getting an annual physical, your doctor and yourself can reestablish you relationship by discussing any changes that may be occurring in your live that may or may not be contributing to any symptoms you may be experiencing. Your doctor can then look over your family history and evaluate whether it is something serious or not or whether at a certain age you need to start becoming more aware of certain physical conditions that may start effecting you and adjust your diet, exercise, or even levels of stress at that point in your life.
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Wrong Diagnosis
At the top of your itemized bill there should be a code that defines what you can to the hospital for. If this code is incorrect, your insurance company may reject reimbursing for your treatment because it may not have been the “protocol” for that particular treatment. For example, if you are admitted for chest pain, and while being tested it is discovered that you have iron deficiency anemia and require colonoscopy/upper endoscopy, make sure the anemia diagnosis is clearly outlined as urgent and the in-hospital evaluation as necessary. If it is not, your insurance company may decide not to pay for the in-patient work up, and you may be stuck with the bill. Most insurance companies have a protocol of treatments they expect the doctor to follow in order to get reimbursed. If your doctor prescribes a different treatment or set of tests than the insurance carrier is used to seeing, it is possible you will not get reimbursed. This is why it is best to catch any problems before they become an issue by reviewing your record as soon as it becomes available. If a problem with your insurance happens, your doctor should have an explanation and be able to write a letter on your behalf stating the reasons the treatment was necessary, based on your diagnosis.
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Erroneous Charges
This could be a $90 charge for a 70-cent I.V or $129 for a “mucous recovery system” (otherwise known as a box of Kleenex). On the other hand, don’t forget to look at erroneous charges such as “surgical supplies.” Be sure you understand what was included. For example, did this include the stapler and suture clip that you were billed separately on your bill? Keep in mind that items in a surgical kit are sterile, so only a few items in the kit may have been used (which is legitimate), but were tossed after the kit was open because it was not considered sterile anymore
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Do Not Ignore Your Bill
As soon as a clinician interacts with you, the billing process begins. However, depending on your health care insurance, income status, bills, and resources, your final bill may be negotiable. You first need to take the correct steps. Keep in mind that if your case involves a car accident or a workers compensation issue, then by law the person that hit you or your place of business where the accident occurred the “workers comp” incident, will get billed first. This means you have an extended period of time to figure out how you are going to pay your bill. More and more medical facilities have hired collection attorneys on a contingency basis to file judgments against people that do not pay their bills. This will go on your credit history. Typically, you will receive at least three statements from the facility before any action is taken against you. In some situations, the medical facilities will file a judgment against you, so if you have acquired any assets you will not be able to liquidate them until all outstanding medical bills are paid. On the other hand, some medical facilities that do not have the means to hire a collections attorney will write off any unpaid bills as “bad debt” if no action has taken place in six months.
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Double Check Before You Check In
Anesthesiologists, radiologist and other specialists don't always accept the same insurance as the doctor who admits you to the hospital. Call your doctor to get the names of the medical providers who will be involved in your treatment, and verify with your insurer that they're in the network. Also, don’t assume that because your physician may be covered by your insurance, that the hospital/facility he/she is performing the procedure at also accepts your insurance. Insurance companies tend to change guidelines every so often, so it is always a good idea to double check the doctors and the facilities with your insurance company before you check in, no matter how long you have been with the insurance company.
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Go To The Emergency Room (ER) For Emergencies Only
The ER is one of the most expensive places to get treatment due to the fact that you will be paying for the staff of specially trained physicians, nurses and other staff to handle health emergencies 24-hours a day, seven days a week, as well as the equipment and other emergency extras. Best to avoid the ER unless you have one of the following conditions: • Severe bleeding • Difficulty breathing • Chest pain or pressure • Broken bones • Partial or total amputation of a limb • Trauma or injury to the head • Sudden dizziness or difficulty seeing • Severe abdominal pain If you have insurance, be sure to find out the guidelines on ER visits including what and who your plan will cover during your ER visit, and what your plan may not cover ahead of time. Your plan may also have guidelines similar to the conditions above that are/are not considered emergencies.
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Health Insurance For People With Disabilities
If you think you are eligible for healthcare resources based on a disability, be sure you get an official determination from the social security administration. You can find the closest Social Security Office near you by going to www.ssa.gov or you can complete an application online at www.ssa.gov/applyforbenefits. The process of determining disability may be difficult and lengthy; however, the National Organization of Social Security Claimants’ Representatives (NOSSCR), which is an association of attorneys who are experts on the disability determination process, can help you out with this process and maybe even for free at www.nosscr.org. If you can prove that there is a likelihood that you will be determined to be disabled, such as a terminal illness, make sure to ask to for a presumptive disability application. This will speed up the process and the Social Security Administration can provide Social Security Insurance benefits for up to six months. If you are denied at first and appeal your case, you might eventually win, but it may take a few years and multiple levels of appeals. In order to expedite the process be sure to document the following (clear documentation is a must): • Disability onset date – give the earliest date that you became unable to work because of your medical condition. • Obtain copies of you medial record from your physicians • Keep a healthcare journal – record all medications you take, you medical symptoms, when you visit the doctor and the outcome of each visit to the doctor. Document dates of every time you feel sick, encounter other health problems, or feel depressed and how long each of these lasts. • A complete Social Security Administration application There are different types of disability plans, so be sure you do your research and find out exactly what is available in your state. The National Disability Rights Network at www.ndrn.org may be able to provide you with some of this information as well as inform you about the protection and advocacy programs in your state. This is a federally funded network that seeks to ensure that federal, state, and local laws are fully implemented to protect people with disabilities. Many of these programs also assist people with disabilities in accessing Medicaid.
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Exercise The “Free Look” Option
Most plans will offer the insurer a "free look" or review period which varies from 10 to 30 days. During this time, if you decide you do not want the policy, return it by certified mail within the required period of time and request a full refund of the premium paid. Most employer group plans do not have a "free look" period, but be sure to inquire if the clause is part of the contract you are considering, before signing.
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High Deductible Health Plans
Most families are paying anywhere from $6,000 to $12,000 in annual premiums for family health insurance, depending on whether you have employer-sponsored group insurance or a privately purchased individual health plan. If you are considering switching to a high deductible health plan (HDHP) to lower your premiums, make sure you understand the terms before deciding. HDHPs, when used in conjunction with a health savings account, (HSA) can be a good option for families in tune with their health care usage patterns.
For example, a family of five would have had an employer contribute $8,950 toward the family's PPO health insurance premiums. The family would have paid another $6,800 in premiums. This family would then paid $300 in co-pays for office visits throughout the calendar year, plus more than $3,600 in prescription co-pays. This would result in nearly $11,000 in out-of-pocket expenses for health care. Even though the insurance company collected nearly $16,000 in premiums from the employer and the employee, it only paid out a little more than $3,000 in benefits to providers. However, if the family had a HDHP instead of a PPO, the same family would have used an HDHP with a deductible of $5,000 and a HSA. If the employer and employee split the HDHP premiums of $7,000, the family would pay $3,500 in premiums. But there is still the $5,000 deductible to consider, so the family could use payroll deductions to deposit that money in equal chunks into the HSA. The family could then turn around and use the money from the HSA, which by the way gets deposited on a pre-tax basis saving the family in the 28% tax bracket, $1,400 a year. This $1,400 could be used for their own medical expenses. The family's gross out-of-pocket expenses would be a maximum of $8,500 for the year. Factor in the $1,400 tax savings, and the net medical expenses for the year are $7,100 or a savings of nearly $4,000 for the year.
If the family's expenses hit the $5,000 mark, the HDHP benefits would become active. However, if the expenses do not reach the $5,000 mark, any money left in the HSA rolls over to the following year earning interest tax-free. Even if the HDHP does not pay out benefits in the year, the security of knowing that should a major medical event strike the family, a family would be covered worthy of the premiums paid. The benefits of an HDHP when the employer does not contribute may or may not prove worthwhile for everyone, so consider the total costs before you decide.
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