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. Make sure the letter is sent using the "return receipt" service, so you'll get proof that the insurer received it.

Under the Affordable Care Act, which you may know as Obamacare, you have several levels of appeal. If it's an urgent life or death situation, the insurance company has to get back to you within 72 hours. For other situations, the appeals process can take months.

"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 an independent third party in the medical field. The insurance company must abide by a ruling in your favor.

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, understand that you may have to foot the bill.
  • Networks matter. Make sure the provider is in your network. Out-of-network visits may not be not covered. If they are covered, they might be more expensive.
  • Get organized. Keep the bills, EOBs and receipts fastened together for easy reference. On the paperwork, jot down names of the people you talk with and any resolution.

 

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