Medical emergencies can happen at any second. It’s vital to not only have health insurance, but also to have an overall understanding of how to reach out to your insurance company when issues arise.
Here are some tips on how to work with insurance companies during a medical emergency and after.
Out-of-Network Services (aka Ambulance Services)
Ambulance services are infamous for not being fully covered by insurance. They’re kind of a wild animal in the insurance game since 99% of the time you’re not able to choose that ambulance service that comes to you (for obvious reasons) and they’re often out-of-network. With ambulance providers billing in the thousands of dollars and insurance only paying for a fraction of the bill, it leaves you with the brunt of what’s owed.
Reach out to a benefit resource center through your health insurance company’s broker (for UnitedHealthcare, for example, it’s the USI Benefits Resource Center) that could potentially help. Brokers like USI speak insurance and can connect you directly with your insurance company and advocate for you when it comes to any of the following:
— Any claim questions/issues.
— Filing claims for out-of-network services (for instance, ambulance services by sending a claim back to the insurance company’s claims department).
— Claim escalation, appeal and resolution.
— Understanding bills from providers.
Also, if you or a loved one is currently at a hospital and needs to have further ambulance services, ask your insurance company for a list of in-network providers within a 10 to 20 mile radius. Provide this list to your case manager. No ambulance service should ever be out-of-network if the transport is not an emergency.
In-Network Services Becoming Out-of-Network
This sometimes happens — for instance, when it comes to having surgery and your anesthesia provider becomes out-of-network (e.g. U.S. Anesthesia Partners and UnitedHealthcare). Or when your PCP becomes out-of-network after you saw them in clinic. If your bill shows that insurance didn’t pay for their share, call immediately.
Your Employer’s HR Manager
Along with a broker, a key advocate during an emergency is your employer’s HR manager. This individual likely has direct contact with a broker that can connect with your insurance company’s higher-ups. This broker can reach out to the higher-ups when it comes to plan coverage issues (for instance, appealing a denial of requested services like inpatient rehab).
What Are Their Phone Numbers? Is There an App for That?
On your phone, add as favorites your broker’s and insurance company’s phone numbers. On top of that, download your insurance company’s phone app so that you have easy access to all pending and posted claims. If something seems off, get ahead of the problem and call your insurance before the bill even comes in.
Avoid That Surprise Bill
Let’s say you’re in need of home health services, outpatient therapy or equipment. Ask your case manager to reach out to your insurance with the billing codes they’ll be submitting to ensure what’s being requested is covered and at what percentage. This helps tremendously so there are no surprises on your end if the case manager decides to throw in something that’s not covered and you get a surprise bill. In short, become friends with your case manager and know what’s going on.
If You Get a Surprise Bill
Often, your plan will cover services rendered. There are times though a certain specialist might be brought in during a surgery that might not be in-network, or a certain drug was used that might not be covered by the plan. Those charges will be directly billed to you since they were not covered, but that doesn’t mean you can’t ask your insurance to cover them (for the full amount or partial).
The health insurance game can be really confusing and frustrating, and that’s OK. Hospitals are sometimes forgiving when it comes to bills, and you can occasionally “negotiate” to lower the bill (e.g. inability to work) or ask to be put on a payment plan. In any case, be proactive when you’re able to, and have family and friends help field incoming bills.
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Tips for Dealing With Insurance Companies in a Medical Emergency originally appeared on usnews.com