Dos and Donts of Higher Deductible Health Insurance Coverage

Do not pay that up front money to the hospital or doctors office!

Many, many companies are switching over to the higher deductible plans instead of the low deductible and copay’s. Why? Because it is helping your company save money which does factor back to you in many ways. But there are tips you need to know now that will save you, the consumer of the new health insurance plans, money as well.

You have rights that you do not know about or are just plain afraid to speak up and ask. Have you at all in the past year or so had to go to the hospital for a procedure? If so, did the hospital call and verify your benefits? Yes, of course or they wouldn’t be doing there job. When they came back to you they were told you have a $1000.00, or $2500.00 deductible that has not yet been met and they want this money “up front” from you. Did you have a slight “anxiety” attack?

Well, you are not “obligated” to give them that. They are not “obligated” to the full amount of your deductible. Use your insurance wisely, it’s your money!

Here’s what happens:

They ask you for $1000.00 up front since your having a minimally invasive procedure ( these are still going to cost an average of $3000.00 and up), and this is what your insurance verified as “not being met” of your deductible or out of pocket expense. So, you write the hospital a check, have your procedure and then your getting bills from other providers ( doctors, radiologists’, pathology, etc) that are saying you owe them. And you probably do because these have already came thru and processed.

The inside story is; your claims are filed with your insurance company but the hospitals are usually the slowest to file there’s, they make take one to three months or more to get there claim to your insurance company. In the meantime the smaller practices such as the pathologist, radiologist, anesthesiologist and doctor close out there billings not long after the procedure is done and can have there claims filed sometimes within a week. In the insurance business it is always “FIRST COME, FIRST SERVED”. Your deductible is met by many other claims before the hospitals claim even makes it thru the door. Then you have PPO networks, discounts, sometimes investigations for some reason and all of this factors into which claim gets released.

The tip here is you have the right to offer what you can afford to the hospital or any other provider out there that wants “up front” money. Offer $100.00 dollars and tell them you’ve been advised to wait for your insurance company to fully process your claim before you pay them any thing else! YOU CAN DO THIS!
They will (most of the time) accept this. This is just standard practice for them. But there is no guarantee your deductible is going to them! Then you are stuck with trying to get a refund from them, this could take months. This is your money, be stingy. Most hospitals or providers are not going to turn you down.

How do I know? I’ve been an examiner for over 16 years, and I’ve seen so many people go thru this. But the new insurance’s being offered now are “consumer driven”. Consumer driven means “You Are In Charge”. You now have to be smarter and know how to negotiate.

Once you receive your “EOB’s” (explanation of benefits) from your insurance company, review who the provider is and how much you owe. All the providers that attended to you in one way or another will get a copy of the same EOB, this is what you owe them and this is what you should pay them. So be in charge, be smart, hang on to your money and delegate it where it needs to go, don’t just give it up to every provider that says “up front” please!