<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Insurance: To Be Covered, Understand It And Plan For It.
 
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                    Insurance Issues - Do You Think This Language?
 
 
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I can't understand why my policy would deny that.

  • Know Your Coverage, Study the Policy.
    One unusual thing about medical care is that it doesn't just occur between the doctor and patient. It's at least a triangle where another party, a big one, also makes decisions. Because usually insurance pays, be it private or government, this is very different from you buying a car or some service. You have to take this into account. The third force in this triangle lives in a different world with a different language, and doesn't know you. While your decisions are based on health, theirs may be based on cost. So the first principle is the know the rules that have been laid down in dealing with them, and that's in your contract. Take your policy, make a short list of the key points, and go over it with your agent to be sure you both agree. It's also wise to go over it with someone else such as your attorney, or a friend experienced in these matters. You can't afford to stumble with these problems. You have to know what this behemoth is obligated to do when making decisions about your care .

    How do I deal with my insurance company?
  • Establish contact with your company, find your case manager or representative if you have one. This is a very important step, because you will learn some problems you can avoid, and likely be able to influence others. Identify your case manager or representative, and get a sense of them. The chances are that they are overworked, with a desk piled high with more cases than they can manage. You also may encounter high turnover or shared responsibility for decisions. You need to be aware of this when they make decisions. For example to approve the tests or treatments, contact a case worker and be sure that they have the records and notes that they need. As we have said, records are often incomplete. Ask if the approval request has enough information. If it doesn't, let your physician know so that more detail or alonger note is important. This alone can avoid many problems.
    If you find your case manager is difficult to work with over time, it may be wise to request a change. This individual has a great deal of influence that is hard to counter. They make what amounts to medical decisions and approvals, without the same training or responsibility that physicians have. The insurance companies counter that that they're only approving the payment as opposed to the treatment, but all too often the two are inextricably intertwined. So it can't be emphasized too much that this is a key relationship to build and monitor.

    What can I do if the insurance company won't approve my treatment?
  • Make your case clearly and broadly understood.
    Many of the approval issues are basically delays. It can be a matter of convincing, insisting, or pursuing other opinions to buttress your case. You can avoid a lot of these by planning ahead if you are a power patient, involved in your care. Some other problems are simple omissions of needed material. The first rule is to read your notes and keep a copy of them so that you know what your doctors arguing for and what was requested. Then check with your case manager to be sure they have that information , and if a down provided to them right away. This builds their relationship and keeps their attention focused on you. If things aren't going smoothly, ask your case manager what else they need for approval. You may find that more detail or some particular line of reasoning was not spelled out. All you may have to do is add this. If that's not sufficient, there are several additional strategies.Stronger notes arguing for approval are one. Use of further opinions is another.

    I don't understand what this independent medical exam is. Will it determine my care, or payments?
  • Understand Independent Medical Exams (IME)
    This is an exam ordered by the insurance company and done by a physician. A contract with. It is confusing because it's not a normal medical appointment or consult. In principle, the physician is trying to provide an independent view of your care, where you are an end, what you need. They also may give recommendations about disability status. They usually do not have the treating relationship with you, which means there's not a doctor-patient relationship. This means that they don't directly prescribed treatment or regularly follow-up. these exams very widely in the nature of the experience, they can be very helpful or create problems. You want to be sure that you are well-prepared for them, and that the physician doing the eaxm has all the material that he needs. Take our free IME Course

    I've been denied, and they won't change after my heel. What do I do now?
  • Contesting Decisions is an art form that resembles strategic planning for a battle.
    There's no question that this is a complicated state to be an it can eat up time and money, both of which you sorely needed this point. The best way to proceed depends on a lot of local factors.. Insurance company rules, local state rules,how effectively your physicians fight, and the personalities of the people involved all key. So there is no guaranted formula. the basic principle is to be sure that you have copies of all the documents necessary records , and a your charities it and put into the insurance companies decision making., next step is to have an attorney involved in this can often be affected. However , the attorneys may have limited resources and time in water often low-paying cases, and it's often the case at the attorney alone is not enough to solve the problem and change the decision. At the very least, it may be a prolonged process going on from months or even longer , as you wait for court date other stages. At this point, you may want to carefully re-examine your insurance situation to see if there's another policy that possibly cover you. This can coud be your wife, or a family member. Frequently when you're up against the wall, it's wise to get the help of your elected representatives. There are a number of factors that influence when they will get involved, but they can be the most effective member of your team..

    The hosptial bill is complicated and high, and my insurance only covers part of it.
  • There are several ways ro fight high hospital bills. First check to be sure it is accurate. They are very complex, based on many codes for different supplies and services. Often these can be erroneous with duplicated services, serivces that were not given, wrong code entry, and codes not allowed to combine with others. There are some companies that will even double check bills for you. Also, the hospital does not expect to be paid the full code price. Medicare, Medicaid, and insurers are all discoutned, sometimes heavily. The full price is usually only borne in legal actions like motor vehicle accidents, patients from outside the country without insurance, and US patients without insurance. This gives you bargaining power. But use it before your credit rating is affected. And even when insurance covers the bill, it may be consuming coverage you will need in the future. It pays to check the bill.
     
  • Use Insurance Well
    It's a shame to admit it, but your health care coverage greatly complicate your health care in many situations. Your care can be determined by someone with no last name, little or no trail, no degree, and no consequences for their decisions. It's no secret cost often overrides the specifics of the medical care recommendation. And it's not unusual to find the full healthcare costs are not supported by a particular plan. A catastrophic illness can overwhelm even the best health care plans. Therefore, with all these challenges and methods in mind, plan on your healthcare needs as soon as you can get a sense of what they involve. This will Saul most problems, and improve most of the rest. As a prepared patient, and a savvy partner, you will come out ahead in both life and health care.

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