Health Insurance Tips and Trends

(How to Effectively Manage Your Health Insurance Policy Without the Headaches)

There are many of us who have had problems with our health insurance carrier, the intention of this site is to avoid those problems and continue down the road to a less stressful relationship with your health carrier and reap some additional benefits you may not have considered.

A little about me and my goal...I have been in the healthcare industry since 1998 and have held multiple positions, 

which cover multiple aspects of the Healthcare industry. I started as Customer Service Rep and then became a Customer Service/host-plan Liaison. 

I then transferred to a Provider Network Coordinator position, then Eligibility Analyst, Eligibility Auditor and now 

I am currently an Operations Business Analyst for one of the largest CDHPs (Consumer Driven Health Plans) in the country.

It's my hope to be able to share my experience in a manner which will prove useful to the general public. So I hope you find this site informative and helpful

in whatever aspect of your health coverage you may be dealing with.

Now I know it sounds cliché and no one really wants to hear it, but once you get your policy you should at the very least look at the highlights of your policy documentation.

• Look for ER "emergency room" policy and general charges

• Look at Inpatient policies and general charges

• Look at Outpatient policies and general charges

• Look for Preventative Care policies and general charges (sometimes there's criteria and limits as well as additional benefits)

• Take note of all important contact info ( customer service #, websites, claims addresses...ect.)

• you should create a folder to keep all of your insurance information in one place

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Detailed information outlined below coming soon:

• Call customer service before you start a treatment regiment. Call to pre certify everything. Even if you are about to go on a referral from your PCP, you don’t want any surprises
• Take notes of all phone calls with customer service when you are requesting pre certification or asking about covered treatment. (you don’t need to record a password change or resource question. You will want to record date, time, customer service rep’s name, and log # or confirmation # for the call (most companies make their CSR’s document all member conversations electronically)
• Create a folder with all policy information and transaction history
• Most policies have a website available so you can find provider’s easily. This is a very useful resource. Still contact customer service before you finalize an appointment.
• Define some terminology….
• You have the right to appeal either before or after treatment. You and your provider can appeal if a pre certification is denied as well as if a claim is denied
• Hold your provider accountable for proper billing
• Ask about 2^nd opinions
• Call carrier as soon as possible after an emergency occurs
• Ask about special incentive programs such as smoking cessation or weight loss programs… it benefits you as well as the insurance company and the company you work for. Overall job security is a good thing so you can do your part too by improving your health.
• Ask about single case agreements if you are in a rural area and can find a provider you like and trust. (a single case agreement is a case by case agreement some carriers will make with out of network providers in cases where there is not another similar Inn network provider within a reasonable distance of your residence or where you happen to be.
• If you have a good experience there is usually an avenue you can take to give recognition to the person who helped you out with a problem. It’s usually very much appreciated and it’s good for your karma
• Keep in mind that there is no system which is flawless, problems can occur and you will usually catch more Bees with honey when trying to get a positive resolution.
• How to handle Pre-existing conditions
• Deductibles
• CPT codes
• Rev codes
• Company’s standard member submitted claim forms
• Provider claim form types UB92 and HCFA
• Ensure provider type is correct for the service you are about to receive
• More and more insurance companies offer free web-based health improvement tools….take advantage of them.
• Where does the money come from? How does health insurance work?
• There are no “stupid” questions
• Define INN and OON
• Define MDR or R&C
• Your employer also has a responsibility to update your carrier with your eligibility information you may need to involve your HR Department
• Having a baby? If you’re going to add your new child to your policy do so as soon as possible after the child is born to avoid issues with claims payments. Your HR department should be able to notify your carrier of the new addition in a timely manner.
• AMA
• Call your health insurance carrier for referrals, in most cases they keep detailed records of health care provider history and certifications, some carriers even employ licensed clinicians capable of making the referrals based on the situation you are describing to them.
• Research your health situation, doctors don’t know everything and there are many resources online.
• HIPAA and how it works, what it means and what to expect
• What pre-certification means and does

This site is under construction. more information to come shortly. sorry for the inconvenience