“The main purpose of life is to live rightly, think rightly, act rightly.” Mahatma Gandhi
“I believe all suffering is caused by ignorance.” Dalai Lama
I am in a position because of my job to have an insight into the workings of the health insurance industry. When you buy health insurance you expect it to be there when you need it the most. These days though you need to check very carefully before you sign up. You may think you are covered when you are not. Here are some of the things to look for based on what I have observed health companies refusing to pay for.
The number one “not paying for it” is preexisting. Do you have asthma, arthritis, cancer, heart conditions, or anything serious with your health that started before you changed insurance? Chances are real good your new insurance will call it preexisting and not pay for it. You may think I’ll go to the Emergency Room if I get bad surely they will pay for Emergency Room visits. Not necessarily. If they suspect your reason for the Emergency Room visit might be triggered by something in the past they will get the emergency room records and they will deny the whole visit.
The number two “not paying for it” is Emergency Room visits. There are some new policies that exclude Emergency Room visits. The insurance company again will check the emergency room records and if they suspect it is an accident where they can get someone else to pay for the liability they will. Auto accidents need to go to the auto insurance company first. So make sure yours is up to date and if you are in an accident caused by someone else that you have their auto insurance information. If your company sends you a form asking if this is an accident fill it out and get it back to them immediately.
The number three “not paying for it” is that’s excluded (i.e. anesthesiologists). You have finally gotten permission for the surgery you need check and make sure they pay for everything. Some insurance companies will exclude the anesthesiologists’ fees from things they pay. Before any procedure make sure you check with your insurance company and see that they are sneaking things in that should be paid for but they are going to try and weasel out of.
The number four “not paying for it” is actually having that baby. Okay your insurance company has paid the pregnancy all along and now oh boy here comes those contractions, there goes that water, and where is the Emergency Room? Surprise! Your insurance company does not classify having the baby as an Emergency. You aren’t covered for it. This is also a problem with some Medicaids so don’t think the States are going to help you there. Before that baby comes find out what needs to be done to make sure the delivery is paid for.
The number five “not paying for it” is we don’t cover that drug. The insurance companies want you to take the cheapest medicine possible. Having trouble sleeping well they will cover the Ambien which will let you get to sleep but doesn’t let you stay asleep but the Ambien CR that will let you sleep through the night forget it, it is too expensive. Are you having cancer treatments? The drug that may save your life is the drug most likely to be classified as “experimental” and not be covered.
“I believe all suffering is caused by ignorance.” Dalai Lama
I am in a position because of my job to have an insight into the workings of the health insurance industry. When you buy health insurance you expect it to be there when you need it the most. These days though you need to check very carefully before you sign up. You may think you are covered when you are not. Here are some of the things to look for based on what I have observed health companies refusing to pay for.
The number one “not paying for it” is preexisting. Do you have asthma, arthritis, cancer, heart conditions, or anything serious with your health that started before you changed insurance? Chances are real good your new insurance will call it preexisting and not pay for it. You may think I’ll go to the Emergency Room if I get bad surely they will pay for Emergency Room visits. Not necessarily. If they suspect your reason for the Emergency Room visit might be triggered by something in the past they will get the emergency room records and they will deny the whole visit.
The number two “not paying for it” is Emergency Room visits. There are some new policies that exclude Emergency Room visits. The insurance company again will check the emergency room records and if they suspect it is an accident where they can get someone else to pay for the liability they will. Auto accidents need to go to the auto insurance company first. So make sure yours is up to date and if you are in an accident caused by someone else that you have their auto insurance information. If your company sends you a form asking if this is an accident fill it out and get it back to them immediately.
The number three “not paying for it” is that’s excluded (i.e. anesthesiologists). You have finally gotten permission for the surgery you need check and make sure they pay for everything. Some insurance companies will exclude the anesthesiologists’ fees from things they pay. Before any procedure make sure you check with your insurance company and see that they are sneaking things in that should be paid for but they are going to try and weasel out of.
The number four “not paying for it” is actually having that baby. Okay your insurance company has paid the pregnancy all along and now oh boy here comes those contractions, there goes that water, and where is the Emergency Room? Surprise! Your insurance company does not classify having the baby as an Emergency. You aren’t covered for it. This is also a problem with some Medicaids so don’t think the States are going to help you there. Before that baby comes find out what needs to be done to make sure the delivery is paid for.
The number five “not paying for it” is we don’t cover that drug. The insurance companies want you to take the cheapest medicine possible. Having trouble sleeping well they will cover the Ambien which will let you get to sleep but doesn’t let you stay asleep but the Ambien CR that will let you sleep through the night forget it, it is too expensive. Are you having cancer treatments? The drug that may save your life is the drug most likely to be classified as “experimental” and not be covered.
The bottom line is this if your insurance will not pay the bill you are liable for it. Hospitals are struggling to stay open. The recession has hit them too. Read that big pamphlet before you sign on to an insurance company. Call their representatives and have a list of questions to ask. If you are looking for a supplemental insurance make sure it pays for what you really need. Ask for help. I go through all the insurance things for my Mom. If they can’t or won’t answer your question so that you can clearly understand be wary. If they want your money make them work for it and make sure they will pay what you need not what they feel like paying.
Posts
No comments:
Post a Comment