insurance

5 ways to reduce medical bills

Problem No. 5: Your request for an important or even potentially life-saving treatment is denied because your insurer wants you to try another treatment first and/or deems the proposed treatment experimental or investigative.

Solution: First, verify that the treatment code isn't too new to be in the computer system. If the treatment still hasn't been classified as customary, get your physician to write a letter of appeal explaining why the treatment is necessary for you, Moaratty says. Put everything in writing, and remember facts, not emotions, are essential. Send the letter certified receipt.

You have several levels of appeal. If it's an urgent life or death situation, the insurance company has to get back to you in 24 to 72 hours. For other situations, the timeframe ranges from 30 to 180 days, she says.

"The more information you provide in the beginning, the less likely you are to get a denial," she says. The first level of appeal is handled internally by the insurance company. The second level of appeal involves review by a nonvested third party in the medical field. You can request that your appeal be reviewed by a specialist in the relevant field for your treatment. If the second appeal doesn't succeed, the third level is to pursue civil action in a court of law.

Rx for an ounce of prevention

Follow these three tips to keep your insurance payments on track:
  • Timing counts. Make sure you're seeing providers on the schedule allowed by your insurance company. If your insurance covers a dental cleaning every six months and your appointment is after five and a half months, you may have to foot the bill.
  • Networks matter. Make sure the provider is in your network. Out-of-network visits may be not covered or if covered, might be more expensive.
  • Get organized. Keep the bills, EOBs and receipts stapled together for easy reference. Jot down who you talked to and any resolution on the paperwork.

Health care reform is on the way. Use this timeline to keep track of when the law's key changes will occur.

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