Summer months for many families include trips to the doctor’s office for annual check-ups and vaccinations. Making sure the family gets the care they need for a fair price is a big responsibility, but with a bit of pre-planning and organization, you can navigate the system successfully. We advise clients to take simple steps to avoid unexpected medical charges, and help them resolve billing disputes when they receive “mystery” bills from healthcare providers. Like all successful family endeavors, organization is a must! The following are several steps you can take to successfully manage your family’s healthcare:
1) Read your insurance policy thoroughly. It may not be a fun summer read, but it is really important to understand your family’s coverage before you ever need it. (If you can’t find your policy, most insurers carry plan details on their web sites.) Review your plan annually to see if your needs have changed and if another plan might better suit your family.
2) If you have a PPO insurance plan, make sure your doctor and hospital(s) are in your insurance provider’s network. Out of network healthcare providers can substantially increase the amount you pay for care. If your favorite doctor is outside of your network, you might want to consider looking at other insurance plans that he/she accepts.
3) If visiting a doctor for a required annual exam (e.g., a child’s vaccination or annual gynecological exam), make sure your provider doesn’t give you optional tests or procedures before you get approvals from your insurance company. If you are wondering if your child has a peanut allergy, you might want to schedule a second visit outside of the scheduled annual check-up. Why? The insurance company may view the allergy test as outside the scope of the scheduled visit, and therefore claim it is your responsibility to pay for it. It’s always good to check with the insurance company first, and confirm with your healthcare provider before any tests or procedures are performed.
4) Keep a “hard copy” file for every family member that includes all paperwork you receive from the insurance company (often in the form of an “Explanation of Benefits” document), and medical bills from doctors, hospitals or other healthcare providers. If you have an issue with the payment of a claim, the documentation you provide will help you present a logical argument to the insurer or provider.
5) Don’t overpay for your healthcare! If you receive a bill from a healthcare provider for a medically necessary test or service that should be covered under your insurance, question it. Billing errors, computer “glitches” and other mistakes cost American’s billions of dollars in overpayments every year. Question every cent that you are asked to pay beyond your premium, deductible and co-pays. The insurance company or healthcare provider can make mistakes, but it is up to you to question the bills.
Leverage and objectivity are critical when you’re facing major healthcare events such as pregnancy or accident/injury/illness. When you’re faced with a medical event affecting you or your family, it is nearly impossible to be objective or give it your full focus. If you can’t hire an expert advocate to help you manage your healthcare, we strongly suggest you call someone who has expertise to help you. Friends don’t let friends navigate healthcare alone!
Be smart, and be well!