What To Do When Your Health Insurance Doesn't Cover Your Medical Care
Having a health insurance plan will save you money in the long run, even though the costs for coverage continue to increase. But no health insurance plan will cover every medical treatment an insured individual needs over a lifetime. No matter how good your health insurance, you may at some point need a medical treatment that is not covered by your policy. Although these situations are normally confined to elective treatments like cosmetic surgery and liposuction, that is not always the case. Ask For A Written Explanation If you are in need of a non-elective treatment that your insurance company is unwilling to cover, and it is not specifically listed on the "excluded treatments" section of your health insurance policy, then ask your insurance company for a written explanation of their reasons for issuing a denial. Show this to your physician. Many times, simply re-coding a procedure or treatment and presenting it again to your insurance company are all that's needed to get approval. But what if you already received a medical treatment, the coding is correct, and it is still denied by your insurance agency? The hard truth is that you do not have many options -- you may end up paying the full cost out of your own pocket. File An Appeal 1 option you have is to appeal a decision you do not agree with. Every insurance company has an appeals process, and you need to follow the steps very carefully. Insurance companies would rather throw your appeal out on a technicality than spend the resources to investigate the claim. The appeal process is usually outlined in your policy handbook. You can also discuss the situation with your medical care provider before proceeding with the appeal to get another point of view or advice on how to proceed. Other Options If, despite your best efforts, a treatment is denied, all is not lost. Here are some other options that may help you avoid paying full price: 1. See if your doctor will negotiate a lower payment or authorize a payment plan. 2. Ask if your doctor is a member of a medical discount program that you can join. Thousands of doctors participate in these networks. 3. If you've not yet had the procedure, shop around for another doctor who will do the procedure for a lower price. 4. See if you qualify for free treatment at a public hospital or clinic because of your income level, veteran's status, or some other reason. With a bit of persistence and some extra effort, it is quite possible that you'll end up with the treatment you need at a price you can afford. |