Comments on: AGING & CARING: How to get your health insurance company to pay up

By: Aging & Caring: How To Get Your Health Insurance Company To Pay Up

Aging & Caring: How To Get Your Health Insurance Company To Pay Up — Sun, 06 Sep 2009 03:05:40 +0000

[...] Aging & Caring: How To Get Your Health Insurance Company To Pay Up [...]

By: Trudy

Trudy — Thu, 06 Aug 2009 15:23:27 +0000

We must stop medical insurance companies from contributing to politicians. Until then and until health care reform, our lives are at their mercy.

Follow the money: the politicians and doctors who do not want reform are benefiting financially from today’s horrific system.

By: frustrated consumer

frustrated consumer — Thu, 06 Aug 2009 12:12:43 +0000

When I try to talk with customer service for Aetna, I get somebody in the Philippines who doesn’t speak English as a first language. How on earth can I explain complicated issues or appeal with the CSR when they can hardly understand me? Asking for a supervisor doesn’t help because they won’t call a state side supervisor.

By: Question Asker

Question Asker — Wed, 05 Aug 2009 19:31:00 +0000

This article doesn’t go nearly far enough and misses an important point. QUESTION your physician on the treatment he is prescribing, BEFORE the service is rendered.

Ask what medical evidence there is to support the success of the proposed treatment for your condition. Why does he think it will work best for you? Doctors have access to the information on whether your insurance company will likely find the service experimental, but we never ask. If a doctor recommends it, we have come to believe that means not only will it work, but it will work better than any other treatment that might be less invasive, or heaven forbid, less costly.

Find out how much experience the doctor has treating your specific condition. Has he performed your surgery 10 times or 1000 times?
Ask him to be specific about the codes he will use to bill your services and what his fees will be, and get it in writing. Then ask your insurance company to help you estimate what your costs will be BEFORE the service is rendered that way there are no surprises.

We would never buy a house or a car without asking any questions, but every day Americans accept their doctor’s word as gospel. It might be, but you won’t know that unless you ask the right questions.

Knowledge is power.

By: Gonzo

Gonzo — Wed, 05 Aug 2009 16:29:36 +0000

I work in health insurance, and this article is very simple. I use the same logic in dealing with my ISP and any other financial transaction I make.

As for the letter of Medical Necessity written by the doctor, have the doctor also relate the previous treatment options. Many times ‘experimental’ treatments are denied due to lack of evidence of other procedures not being tried first. Have the doctor produce copies of your medical records to support the letter of medical necessity.

As a note, skin tag removal will be denied. No matter what your doctor says about that wart or mole or blemish, they won’t pay for its removal. Accept this, pay for the cosmetic surgery and move on with your life.

Also, read your policy before you call the HMO. If there is a copayment, or a deductible, you will have to pay it. Just like you would have to pay a high way toll, you won’t get out of it. No matter what your great aunt mildred did once, you won’t get out of it. Don’t waste your time trying to.