It's been a few years since you've had your last physical and you have this insurance plan through work that takes a monthly sum out of your paycheck-so what the heck, why not get a check up? You find a doctor in your insurance provider's network, make an appointment, and check that task off your things-to-do list.
If this is all you've done to make a doctor's appointment, you haven't adequately protected yourself against a surprise bill from the doctor's officer following your visit. Just because a doctor is in your insurance provider's network does not mean that same doctor is covered under your plan. The previous hypothetical is one of several ways ordinary people get hit with big medical bills due to a lack of due diligence on their part and a false sense of security that they're covered. Ensure that you're fully covered before seeing a doctor or specialist by asking yourself the following questions.
Is the doctor or nurse familiar with my plan?
Doctors and nurses want to make sure that you're covered just as much as you do. They're much more comfortable getting paid by your insurance provider rather than by you. That being said, don't hesitate to ask in a straightforward manner whether your policy covers a specific doctor or procedure. Additionally, to be absolutely certain that your visit is covered speak with an insurance claims manager in the officer either in person or by phone. These managers will work hand-in-hand with you to make sure you understand what is covered and what is not. Insurance claim managers are often Certified Medical Assistants (CMA) so they have a wealth of knowledge about health insurance. The more questions you ask them, the better off you'll be.
Is the doctor covered under my plan, not just in the insurance provider's network?
Similar, to the hypothetical, don't be fooled into thinking that a doctor is covered under your plan just because that doctor is in the insurance provider's network. It's common for plans to not include all the network doctors.
Is my name on the claim the same as it appears on my insurance card?
Avoid any unnecessary headaches by confirming the correct spelling of your name on the claim and your insurance card. Insurance providers will deny or reject a claim for such an administrative error. Sure, you can probably appeal the denial or rejection and get it reversed, but why bother going through red tape that could take months to resolve?
Is this medical bill accurate?
After doing your homework you still may receive a medical bill if a procedure was only partially covered or you went into a procedure knowing that it was not covered. That doesn't mean you should not closely look at the bill. Believe or not, medical providers and insurance companies make mistakes. Be sure the charges are accurate and if you're not sure about a few charges contact the appropriate entity for clarification.
Remember the adage, it's better to be safe than sorry. That applies when finding a doctor under your insurance provider. Save yourself time and money by asking yourself, your insurance provider, and healthcare providers the right questions.
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