Content Overview
- Summary
- Keep Track Of Out-Of-Pocket Medical Expenses
- Keep Your I.D. Card With You In Your Wallet Or Purse
- If You Have A Choice, Balance Premiums, Deductibles, Co-Insurance, Stop Loss And Benefits
- Minimize Out Of Network Costs. For example, if You Agree To Surgery, Make Sure All Members Of Your Surgical Team Are Part Of Your PPO.
- Negotiate Fees With Out-Of-Network Health Care Providers
- Avoid Paying Money In Excess Of Usual, Customary And Reasonable
- Think Of Case Managers As A Resource
- Stay On Top Of Insurance Company Reimbursements
- Be An Informed Consumer When Purchasing Drugs, Tests Or Treatments.
- If You Smoke, Quit.
- If You Need An Off Label Or Experimental Treatment, Work With Your Doctor To Get Coverage
- Don't Accept A "No" From The Insurance Company.
- How To Choose And Maximize Use Of Doctors And Specialists
- Take Advantage Of Your Plan's Mental Health Benefits
- How To Keep Your Doctor When You Change Health Plans
- Insurance Policies Are Not Set In Stone.
How To Maximize Use Of A PPO Health Insurance Policy
Don't Accept A "No" From The Insurance Company.
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Fight for a "yes." Studies show that persistence pays off.
Follow the insurance company's appeal process. Pay close attention to the dates set by the insurance company by which various actions must be taken.
Once you have exhausted the company's internal appeals, appeal externally if you have that right under your policy or the law of your state. (You can learn about the law of your state from your Insurance Department. Contact information is at www.naic.org . For policies issued on or after September 23, 2010: thanks to Health Reform 2010, you have the right to an external appeal to an independent reviewer.
To learn about time tested arguments to use, see Arguments To Use Against An Insurer's Denial Of A Health Claim.
Get help for the fight if you need to. Consider:
- Getting the help of an experienced insurance attorney.
- Using all sources of influence. For example, if you have your insurance through your employer, ask the person at the company who deals with insurance matters to speak with the insurance company.
- Speak with your disease specific nonprofit organization. Perhaps they have information that could be useful.
- Consider applying public pressure via television, radio, newspapers and/or the internet.
Ultimately you can complain to the state insurance department. It supervises all insurance companies which sell insurance in your state. You can find the contact information for your insurance department at www.naic.org .
You can also start a civil action in the courts.
To Learn More
More Information
Arguments To Use Against An Insurer's Denial Of A Health Claim
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