15 Things Your Health Insurance Company Doesn’t Want You to Know

5 minute read

By Christopher Brown

There’s an air of finality to the invoice that your health insurance company sends your way. But it’s a business and there can be wiggle room. Fortunately, you can learn everything you need to know about health insurance with a search online.

These days, you can’t count on your health insurance company to look out for you. You’re on your own. That is, until now. With this in mind, here’s what your health insurance company doesn’t want you to know,

It’s a Business

Health Insurance companies design the coverage plan, they decide to approve or deny your claim and they’re responsible for footing the bill on all of the claims that they approve. Now, this would be fine if all health insurance companies were impartial, altruistic enterprises… but you and I both know that they are anything but altruistic.

Health Insurance companies are a money making enterprise, and are motivated by a lot more than just your well being. You may have to battle tooth and nail to get your claim approved. And, as sad as that may sound, that’s how the system is built.

Create a Paper Trail

This may seem counter-intuitive, time-consuming and a little old-fashioned, but formal complaint letters to health insurance providers get the job done in a variety of different ways. For starters, penning and mailing a good old-fashioned letter could save you from having to endure hours of on-hold jazz tunes.

More importantly, it provides you with a communication paper trail. It’ll provide you with evidence that can aid a future appeal (if it even gets that far), and you’re almost guaranteed to get a response. Just do a little research to make sure your strongly worded letter ends up in the right hands.

You Can Fight

So… your insurance claim is denied and you’re stuck with another hefty medical bill. Game over.

Well… not exactly. You see, your health insurer is hoping beyond hope that their firm rebuke will be enough to send you scurrying back home. But in reality, health insurance companies have an appeal process.

Get your documents in order, do your research and be prepared to fight for what you deserve. Expect them to fight back but don’t be afraid to reach out for professional help if necessary.

Symptoms Sell

This shouldn’t come as much of a surprise, but insurance companies really, really don’t like to spend money. As a result, patients are often denied their request for costly diagnostic tests like colonoscopies and CT scans.

It may sound a little backward, but it really is up to you to sell your symptoms. Prepare a list, write down specific real-life examples and be ready for when your doctor asks “why?” It may save you and your wallet a whole lot of trouble.

More Than What You Bargained For

I can’t say this enough: Health Insurance Companies only look out for Health Insurance Companies. So, don’t be surprised if they “forget” to mention specific state-mandated coverage options.

Coverage can vary dramatically from state to state and the onus is on you to learn about it. Families USA, a consumer rights group, is a great place to start.

Use Your Doctor

Massage Therapy, Physiotherapy, Counselling… these therapies can improve your quality of life dramatically in certain cases. They also get denied fairly regularly.

If your doctor recommends physiotherapy but your health insurer says “no mas,” reach out to your doctor. MDs can complain to the state board and, in turn, hasten the approval process.

Research, Research and More Research

In some instances, doing a little bit of digging on the internet can help persuade doctors and health insurance companies to give the green light on a variety of expensive tests or therapies.

Curious about getting a CT scan? The internet is full of patient stories just like yours. Arm yourself with the appropriate knowledge so that you’re prepared when you really need to be.

That said, be careful when you’re researching symptoms and the like online if only to save yourself the mental anguish of an incorrect self-diagnosis.

It Doesn’t End With Your Deductible

Many patients assume that their payments end once they cover their annual deductible. That isn’t always the case. Co-pays and other medical expenses can really catch you off guard if you’re not prepared.

Knowing how much you stand to owe and budgeting accordingly can go a long way. Know your plan, and don’t be afraid to call your insurance provider to clear up any questions that you may have.

No Say, No Pay

Most Health Insurance providers limit your coverage to doctors that are in your respective network. That much is known. So naturally, you expect to receive a hefty bill for straying outside of said network. But, if you don’t have a conscious choice, then you shouldn’t be liable.

For example, when you have surgery, the hospital is responsible for selecting your doctor. Receive an “out of network” bill post-op? Fight it!

Save on Drugs

Much like cereal, t-shirts and handbags, name-brand pharmaceutical drugs often have a generic, more affordable counterpart. It’s your health, and you’re entitled to ask questions about the medication that your doctor is prescribing you. There’s absolutely nothing wrong with asking for more affordable drug options.

One simple question could save you hundreds per year. And that’s good for your health too.

Patient Advocates to the Rescue

If you know anything about health advocacy then you know that hiring one could save you a whole lot of money.

Health Advocates fight for patient rights. In the context of Health Insurance Companies, patient advocates work to solve your healthcare woes. They can be an incredibly valuable resource and I highly recommend seeking one out f you find yourself backed into a very expensive health-care corner. This Patient Advocate website is a good start.

Out of Network Expenses

Most patients just assume that they’ll have to foot the bill for any out-of-network expenses. But that’s not exactly the case either.

Sure, if you opt out of available in-network specialists, you’ll be forced to pay out of pocket. But, if your community doesn’t include a specialist in its network, you can seek written permission from your insurance provider. It never hurts to ask!

Mental Health Might Not Be Covered

Back in 1996, the Mental Health Parity Act was signed into law in a relatively large step towards a wider availability of mental health services. Before then, insurers weren’t responsible to provide coverage for certain Mental Health related medical costs.

But the grass isn’t exactly greener just yet. It’s important to read your plan to make sure you’re covered before you schedule costly treatment.

State to State

National Health Insurance companies aren’t all created equal. In fact, most insurance companies offer dramatically different coverage packages from state to state. That’s because plan requirements vary from state to state due to radically different Health Insurance mandates.

If you’re married, or shopping for individual coverage, throw the company’s national reputation out the window and compare your options side by side. It could save you a fortune.

Price Shopping Procedures

Making sure that you stay in the network is of top priority for health insurance providers. It’s a whole lot cheaper for them and as such, they’ll do anything that they can to ensure that you stay within your community.

For example, try asking your insurance company for an out-of-network procedure quote. You’ll get one, but not before you’ve spent a long, long time listening to on-hold jazz music.

Christopher Brown