Words Health Insurance Policy with a squiggly line below

Even when a person has health insurance, healthcare in the U.S. is largely inaccessible. Copays and deductibles are enough to put people in thousands of dollars of debt. Investopedia cited an NPR poll that found, “27 percent of respondents struggled to cover food, utilities, and housing expenses because of medical bills.” In fact, due to the impact medical bills have, “Medicare for all” has become a popular political conversation, as more Americans are unable to afford healthcare and begin to compare our healthcare system with that of other countries.

However, even as more people recognize the injustice of paying large sums in order to simply receive care, there are not a lot of options for Americans to fight the system, apart from voting. Until legislative changes are made to favor individuals over insurance and pharmaceutical companies, we must make do with the system we’re working in, which means recognizing the manipulative loopholes insurance companies go through to avoid paying bills, and disputing them to ensure you’re given the coverage you pay for.

After Insurance Pays

As unethical as it seems, medical insurance companies often do everything in their power to avoid covering medical bills. Insurance claims tend to involve a lot of paperwork that can be confusing to navigate, which can prevent some people from ensuring they were covered for the correct amount. Insurance companies count on this in order to get away with underpaying medical bills. When this happens, you can address it, and get them to cover their fair share.

Understand Your Plan

The first step to making your insurance company pay their dues is understanding your insurance plan. Having a good understanding of your plan can help you save money by not only making sure your charges are being covered as they promised, you can sometimes even find discounts offered by the insurance through your plan. While you don’t necessarily need to understand the entire extensive document, you should keep a copy of it on hand for when you need to see what’s covered. Often times, people seek coverage that is specific to their chronic illnesses or conditions, and in these cases, it’s good to become familiar with you plan so you can distinguish when something was improperly covered.

Consult Your HR Department

If you have insurance through work, you have access to a knowledgeable resource through your HR department. It is usually the HR department (or designated benefits coordinator)’s job to shop around for the best insurance for the company, so they are well versed and familiar with what the company insurance plan offers, and they’ll be able to tell you if more of your medical bills should have been covered. If that’s the case, they may be able to call the insurance company and advocate for you to get the proper amount covered, knowing exactly how to address the situation.

Contact the Insurance Company

This step can often take a while, so be sure to give yourself a timeslot of at least an hour when calling your insurance company. Sometimes you can address an unpaid situation simply by calling and asking questions about why a bill wasn’t covered. Upon exploring the situation more, the company may find there was error in the information, or that it was billed incorrectly by the healthcare facility. If it’s not that easy, you may need to call multiple times, address supervisors, and send documents in the mail to clear up whatever error that might have been.

Appeal the Claim

If the insurance claim looks incorrect to you, you have the right to dispute the claim with an internal appeal. After the insurance company conducts an internal investigation, they might find a mistake in the appeal. However, if nothing is found internally, you can appeal the claim externally.

Verywell Health citeda Government Accountability Office study that found, “Appeals resulted in reversed rulings by the insurers in 39 to 59 percent of the cases.” This proves that it’s worth appealing and getting a second opinion as it may save you a large sum of money.

Know What Your Policy Covers

Although we should not have to think extensively about going to the right place to get the care we need when we’re sick, often times this will prevent you from getting billed extra by your insurance company. Medical care costs can be more or less expensive depending on the facility you go to and whether or not they’re in-network. You’ll likely have a co-payment for the exam, but after that, anything else that your doctor examines will cost you.

This includes regular STD testing, as an exam for each disease or infection will result in additional costs to your insurance and to you. Sometimes, they pay minimal amounts for these exams that are considered optional; therefore, if there’s a more affordable option without insurance, it’s a good idea to take advantage of it.

Insurance companies are often a pain to deal with, and it can be extremely frustrating to have to argue about the cost you’re being forced to pay for necessary procedures. Medical bills can quickly put you in a risky financial situation, and while this can be unavoidable, it’s a good investment of time and energy to make your health insurance work for you. This requires you to understand your plan, ask for help, make calls, and possibly appeal the claim through various avenues, but it can end up saving you thousands of dollars in the long run.