• Choosing insurance: Company "report cards" for HMOs (health maintenance organizations) and POSs (point of service plans); if you have a choice, check before you chose a particular company for coverage.
• Noncovered services: many plans will not cover annual well visits and some other common things like birth control pills. Therefore, whatever you pay out of your pocket for such services, remember that it noncovered services costs will not be applied to your deductible. Therefore,
  • if you have a complaint or problem that you know that you'd like the doctor's consultation on during your annual visit, be sure that the office does not schedule you for a "well visit" or "annual check up"...let the annual check up occur at the same time. At the visit, "By the way, it is time for a quick check to renew my birth control pills". Before you leave, check with the office and be sure that they code the visit right, "Is this visit coded in a way that my insurance will pay?"
  • If you are going to be using a doctor regularly for some period of time, try to become friends with someone in their insurance office and let them know..."We are on a tight budget, can you tell me what my insurance is going to pay? Why won't they pay that? Are you sure that it is coded correctly...do we have any options that will help me?"
• Getting the "right" provider and/or service you need:
  • check with provider in advance & be sure they are recognized by your insurance:  If your doctor recommends a specialist be sure that physician is an "approved" MD of your insurance. If not, find out from your physician why he recommended that particular physician. Ask him if there is another MD able to do that procedure equally as well from your list of approved providers. If so, try to go to the one with your insurance approval. If not, call ahead to talk with that doctor's office and see if they know whether your insurance will pay anything at all; and ask if they would give any kind of "prompt payment discount" if your insurance would poorly pay them. Or, ask your MD to write a letter to the insurance company on your behalf, stating the reasons he is recommending this particular out-of-network physician (you may want to offer to type such a letter up for them on their letter head)!
  • check with insurance to be sure that non-emergency tests and procedures are covered: When visiting a specialist or special hospital or test area for any reason, or when you are having any tests done, don't rely upon your family doctor to make the arrangements with your insurance company. Always know what your insurance company requires and contact them for prior approval. Always take a "copy" of their letter of approval with you to the specialist or hospital. But, never, never, give away your copy of the approval letter! Unless the doctor says that the study is urgent and critical, you can always ask to delay until you can check out whether you can afford to have it done. The office of the lab, doctor, clinic, or hospital that you are being referred to should be able to help you...it is likely that they "want your business".
• Employer benefit plans: Be sure to ask for a look at the entire choice of plans.

  • young healthy people tend to do well with HMOs and PPOs

  • young healthy people with healthy children (or all the family history suggests children will be healthy) tend to do well with HMOs and PPOs

  • insurance types with options to choose the provider are better if you think that there is any likelihood of a serious chronic illness (quite a heavy percentage of such illnesses are lifestyle related...check out ***the impact of faith***)

  • cafeteria plan: some companies provide a pretax payroll deduction which you can use during the year to pay for non-covered or unpaid expenses. You pay with pretax dollars rather than out-of-pocket dollars on which taxes and government stuff has been taken out. But, if through poor planning, you fail to use this money, you lose it to the employer.

• Stretching your health dollars:

• Some secrets to success (whether in advance planning or straightening out problems later):  
  • Attitude: have the right mental attitude
  • Gather documentation: Begin by buying a notebook or file of some kind that will hold all your bills, insurance payment reports, and has blank paper for you to right on!
  •  Write down who you talked to: Always, always, ask for the full name of the person you are speaking to whenever you have reason to call. Write down the name of the person, time and date you talked with them and the purpose of your conversation! (This has saved me money, when I had this information in the past and called back only to learn the previous person I had talked with no longer worked there and they had no record of my call to her). This will help appeals persons to go back to company-recorded phone conversations. (If you are set to do so, you can record the conversations yourself...be sure to tell them.)
  • Be persistent: Never give up! The insurance company can and does make mistakes! They don't mind doing their job well with your help. If the insurance company doesn't pay what you think they should or your policy says they should, don't hesitate to call and ask them about it. It may just be an oversight because your policy is unusual. 

  [back to the main advisory index page]

(posted August 2001; latest update 13 September 2002)