7 Ways to Cope When Your Health Insurance Drives You Crazy


Health care spending has been a high profile issue for years now. You deserve good medical care- including prevention and the most effective treatment for your medical condition. Having a stroke risk factor or having a stroke is stressful enough without having to worry about who will pay the medical bills. Maybe you have spent a chunk of your salary to pay premiums for a health insurance plan. Or maybe you have suddenly found yourself jobless, struggling to pay your bills, and have gone through the paperwork to obtain health coverage for your family while you look for a job.

Either way, it is disconcerting to suddenly find yourself in a bind when your doctor recommends a diagnostic evaluation or a medical treatment that your health plan doesn't cover.
Doctors get frustrated when they can't get the best care for their patients. Health plans also try to cut costs by avoiding payment for unnecessary tests and medications. That leaves you, the consumer who is trying to get better, in a bind.
So what can you do? There are some ways you can cope with health care denials to get the best care with as little hassle as possible.

1. Pay Attention to Repeat Tests

Keep track of which medical tests have already been done. Many patients go to a neurology specialist after a stroke. If the neurologist says that a diagnostic test is necessary, patients often assume that means another brain MRI or another neck CTA, even if one has already been done. However, often a neurologist is located at a referral center, even if the doctor who initially saw you for your stroke symptoms is located at a community hospital or office.

More often than not, privacy rules prevent a doctor at one medical system from looking up your records at another medical system. If you already had a recent test, your specialist might not have easy access to that information, and will need your formal permission to request the results, possibly eliminating the need for a redundant test.

2. Just in Case

Often, when you are referred to a neurologist, someone along the way also orders 4-5 tests ahead of time ‘just in case’ the neurologist might want them. If your insurance company denies the tests, and then the neurologist recommends that you have only 1 or 2 tests after she sees you, there is no need to worry about the previously denied tests. Because the neurologist likely narrowed down your health problem, usually only a few tests are necessary to diagnose your problem.

3. More Doesn't Always Mean Better

If you have read or heard of a medical test or treatment from friends, by all means ask about it. However, there may be some subtle reasons that it isn't suitable for you and you should never hesitate to ask, 'why not?' because the answer will very likely put you at ease.

4. Alternative Treatment

Most health plans draw the line at paying for some of the alternative treatments that have not been proven safe and effective. Until a diagnostic test or new medication passes muster with evidence-based medicine guidelines, it may be tough to get coverage.

On the other hand, if you want to try something that is still in an experimental stage, you might be able to enroll in a research study and have your care covered as part of the research costs.

5. Ask to Speak to Someone in Charge

All health insurance companies have an appeals process in place. Sometimes the physician’s office calls about appeals, and sometimes the patient calls, depending on the insurance company policy. The people on the other line who review your appeal may seem intimidating, but they are not monsters. They should listen to your complaint, they shouldn't hang up in you and they should provide you with a response in understandable language that doesn’t contain too many medical or legal terms.

6. Don't Hesitate to Rate Your Insurance Company.

This is a very new concept, but consumers are beginning to hold more power than ever before. If only one of your coworkers lets your employer know that your health insurance is inadequate- it is highly likely that nothing will change. However, if you comment and other coworkers add their input too, a realistic picture of the health plan’s performance will finally emerge. The same holds true for rating your health insurance using online sites for consumer reviews and ratings. Make sure you rate both good and bad service. Because people tend to rate services more often when they are angry, many ratings sites list a reviewer’s history. But if you rate good and bad health care (and even average) it will make your evaluations more believable and it will reward those who provide you with good service.

7. Read the Fine Print.

This is the most unpleasant part of getting your health care denied. If your health insurance carrier states that they won't cover something- they really have no obligation to budge. They can easily say that they aren't putting you in danger because you can have the service that you want  (but don't need) at your own expense - they just won't pay for it.

It can be stressful when your health insurance says no. An empowered patient can get the most out of health care for better health.

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