9 Ways to Beating the Health Insurance Woes

by Jamie Simmerman · 5 comments

Paying for health insurance expenses has become an ever-increasing source of irritation for many consumers. Even those fortunate enough to have decent coverage often find themselves squinting at long lists of detailed pages written in what appears to be a foreign language that only accountants or insurance clerks understand. For the average consumer, sorting through the health insurance jungle is a daunting task.

Beating the health insurance woes begins with understanding a few basics about how insurance works and what you need to know to get the most from your insurance. Here are 9 tips you need to know.

1. Your explanation of benefits sheets are important. Don’t just throw them in a file without reading them! These EOB sheets outline what has been billed to your insurance company and what your insurance company plans to pay. Important information like the date of service, services rendered, and the amount of each service or product are listed on the EOB. Pay close attention to what is on every EOB you receive. Mistakes are common and unless you catch them, you’ll end up paying more for your health services than is necessary. Common mistakes include denial of payment due to incorrect billing information or transcription errors, bills for services of products not received, and out of network services that were beyond your control. I’ve seen patients who were billed full price for an ambulance ride because the insurance company claimed they needed prior approval to go out of network and obtain the services of the ERS company that 911 dispatched! A simple call from the attending physician verifying the emergent nature of the injury changed the insurance company’s stance on making payment, but if the patient hadn’t read the EOB, the charges would have become lost amidst the multitude of charges incurred during a lengthy hospital stay.

2. Don’t be afraid to question anything you don’t understand. And if you don’t get a satisfactory answer, keep pressing for more information or ask to talk to another representative or supervisor. Call your insurance company to inquire about any suspicious charges that show up on an EOB.

3. Take your own prescribed medications with you to the hospital and make sure you aren’t billed double for pills during your stay. Even a simple dose of Tylenol can cost over $10 from a hospital pharmacy. The medical staff will most likely need to keep your personal medications locked up for safety reasons, but using your own supply from home can help save you a bundle if you are in the hospital for an extended stay.

4. Pack items such as socks, a toothbrush, chapstick, and toiletries when you have a planned hospital stay. This will save you a bundle especially for overnight or outpatient visits. Medical staff generally don’t think twice about grabbing a pair of grippy socks or a bottle of mouthwash for a patient, and these items are billed at high rates.

5. If you use your health insurance primarily for colds, flus, sprains, and a yearly check-up, consider opting into a plan with a higher deductible and lower monthly premiums. You can save money at the end of the year if you don’t visit the doc too often. Just make sure you do the calculation and don’t skip the doctor visit just because you have to pay.

6. Ask your doctor about sample medications or manufacturer coupons for any medications you take. Print out a drug formulary from your insurance company and take it with you to your next appointment. Together, you and your doctor can select a medication that is less expensive and still effective for treating your condition.

7. Know your plan details. If all that insurance jargon befuddles you, take the time to look up the details and translate the language into wording you can make sense of more easily. If you don’t know what you’re paying for every month, you don’t know what services are available and which ones will cost you more out of pocket expenses.

8. Don’t be afraid to shop around for health insurance. Many professional organizations offer group insurance plans (like Grange, Farm Bureau, AARP, and the Writer’s Guild). If your employer offers a measly compensation package, you may find better services through an outside agency or through privately purchased health insurance.

9. Look into starting a Health Savings Account to plan ahead for medical expenses. You can always use the leftover end-of-year money to stock up on over the counter medicines, first aid items, or a new pair of glasses or insoles for your work shoes.

Insurance companies are out to save as much money as possible, and as the consumer, you should adopt the same attitude to keep from footing the bill for the insurance company’s corner-cutting practices. Be vigilant and be persistent in dealing with your health insurance company.

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{ 5 comments… read them below or add one }

Marbella November 24, 2011 at 6:33 am

I live in Europe and commute between Sweden, Spain and England. We have roughly the same health care systems in all countries and we do not have to pay more than 10 – 15 dollar for doctor visits, surgery or medical care. Our health care system paid for by taxes in each country.

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Kristina November 24, 2011 at 8:55 am

Re the EOBs, I check those very carefully and compare them to the doctor bills I receive. When health care providers contract with an insurance company, they agree to accept a set fee for their service. For example, the doctor may charge $200 for an office visit, but when they contract with the insurance co, they agree to receive $100 for that service. Some doctors turn around and bill the patient for the other $100. It’s not illegal, but I think it’s unethical. When your EOB tells you what you owe, that’s what you owe. When the doctor bills me, I compare what they’re saying I owe to what the ins. co. says I owe. And that’s all I pay. Most bills line up. Some don’t. I advise people NOT to pay what they don’t owe because they don’t owe. Please blog about this because it drives me crazy. It’s so unfair. Thanks.

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irene December 11, 2011 at 7:01 am

I agree. It’s very unfair and very unethical. The average person doesn’t realize that the doctor signs a contract agreeing to be paid ONLY by the insurance company and NOT the patient. It is unethical and you can be kicked out of the insurance company as one of their providers if you bill patients, too!

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Diedra B November 24, 2011 at 5:57 pm

I once found out a therapist I was visiting regularly was unintentionally billing me for weekly visits when I was actually visiting once or twice a month. He cleared it up with his billing staff but if I had not checked the statements from the insurance co. I could have easily used up all my available payments and not received the corresponding treatment!

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Thad P November 26, 2011 at 6:05 am

The level of details you have to pay attention to is almost overwhelming. Healthcare providers outsource so many things it is a real challenge to associate the items on an Explanation of Benefits with the bills you receive from the provider. And add to the mix that sometimes there are months and months between when you went to the doctor or had something done at a hospital and when you actually receive the bill with what you really owe.

Not easy, and doesn’t look like it will get any easier.

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