Understand your Coverage

Last week I talked about getting large hospital bills and what to do if you received a large hospital bill. Today I’m going to give you an example of why it is so important to question everything. And to understand your coverage.

Last June, Baylor Scott Insurance was fined $60,000 by the State Board of Insurance for failure to pay claims properly, denying prior authorizations, and denying coverage. The lesson we can take from this is to evaluate everything related to your bill!

I cannot stress enough, make sure you know what you are billed for, what your company pays, and what insurance is covered on your bill and why!

For all insurance companies, unfortunately, the reality is, just like we check our bank statements, we check our credit cards, things do happen; you have to be your advocate, and make sure insurance pays properly. Yes, it’s annoying that you must spend time doing this. But again, it’s your money.

Remember, you should get the benefits that you’re paying insurance for. You want it to pay like it says it’s supposed to pay in the policy.

You can file complaints with the State Board of Insurance.

  • The more people who file complaints, the more likely they are to investigate it.
  • The Baylor Scott and White insurance incident was due to an audit.
    • I am sure there were plenty of complaints that helped prompt that, but all insurances can go under random audits, with the State Board of Insurance to determine if they’re doing things in the right way.

Also, be aware that the medical office may be misinformed. You need to be your advocate when you go to medical offices, if they tell you your insurance doesn’t cover this, or your copay is this, or they say you don’t have a deductible, they are can be clueless or untrained. It is just really important to figure this stuff out for yourself.

You have to understand your policy and question, question, question everything!

  • If you don’t think it’s right, compare what insurance says it pays versus the bill you got.
  • Make sure that’s right
  • Check your bills: you can see if things match up, and if it’s a large amount, call and see.
  • Look at the coding – you can actually Google the codes and look up and see what’s what that is.
  • Ask for itemization
  • Never pay the first bill – question it first!

If you have questions, please feel free to reach out to me.

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Austin, Texas

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