Exercise Your Life #2: Wrangle Your Health Care Costs & Benefits

Working out the costs and benefits of your health care can feel like you’re trying to lasso a bronco, especially when Mr. Insurance Company is involved.  He goes in one direction, and then all of a sudden, he bucks away and, just like that, denies your insurance claim.  I’ve had quite a few frustrating experiences like this.

I recently needed a new night guard, but I wasn’t going to have my dentist make it until my insurance benefits were checked.  The administrative assistant at my dentist’s office offered to call my insurance company.  They gave her the go:  I had benefits to cover a new night guard.  A night guard was made and the claim was submitted.

Denied!

We all fought the denial.  My dentist submitted paperwork for a reconsideration.  Denied again.  Then my dentist took pictures.  She called them.  I called them.  Nothing worked after several months of fighting the wild horse.

I was now left with a $500 piece of dental equipment I didn’t want to pay for out-of-pocket. Fortunately, my dentist ate the cost of what my insurance company would have paid (I have a nice dentist).  But really?  This was my fault.  I should have been the one to call my insurance company and ask whether or not I had coverage for the night guard.  I probably would have discovered ahead of time that tiny little reason they used to deny the claim.

Your Are Your Own Health Care Boss

If you have health insurance, know your benefits and verify them with your insurance company yourself.  Don’t rely on office staff to talk to your insurance company for you.  Knowing your insurance benefits is your responsibility.  It is not your doctor’s responsibility to know what your insurance covers and what it doesn’t.  When your doctor’s office provides you with that information, it is a service that they are providing to you for free.  It’s not their job to get it right, it’s yours.

When you receive a previously approved insurance denial, it can result in an ethical dilemma.  Is your doctor financially responsible for what your insurance company denies?  Just because your insurance company can’t be tamed with a piece of rope doesn’t mean you shouldn’t ride your own health horse.  You are the only person responsible for your health, and that includes what it costs to take care of you.  You wouldn’t expect your doctor to come home and cook you a gluten-free vegetarian meal for your new diet, would you?  Same goes with money.  Your doctor is not responsible to pay for your health care costs.  You are.

Being versed in your health insurance plan is especially crucial when it comes to alternative healthcare.  Some insurance companies include naturopathic physicians in their plans.  Others don’t.  If you want your insurance to pay for your alternative healthcare services, talk to them yourself.  Sometimes you can receive reimbursement for seeing a naturopathic doctor, even if they are out-of-network.

How to Best Wrangle the Health Insurance Bronco

1.  Call your insurance company.
2.  Record the date.
3.  Record the insurance rep’s name (he will usually give you his first name).
4.  Record your benefit questions as well as the answers.

If your insurance company denies a claim you previously discussed with your insurance company, it’s much more powerful to say, “I talked with ___ on this date and this is what he said…”.  You have less of a fighting chance if you say, “Umm, my doctor’s office called you and they said that you said…”.  You run into the he said she said thing, and it just doesn’t work.

For those of you who don’t have health insurance, think of something else to grab by the horns.  Is there something you can do to access the healthcare you need?  Is there low-income state insurance you could apply for?  Have you looked into health clinics that offer a sliding fee scale based on your income?  Have you investigated student clinics that often provide care at a very reasonable price?  Have you investigated the possibility of getting catastrophic health insurance if you can’t afford the basics?

What part of managing your healthcare do you need to lasso?

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