IADE Blog

HOW TO BEAT YOUR INSURANCE COMPANY – AVOIDING LARGE MEDICAL BILLS

THE PROCEDURES YOU NEED TO TAKE TO MAKE SURE YOU DO NOT GET A SURPRISE BILL

How many times you get a surprise bill from your doctor asking for money that your insurance did not pay due some technical mambo jumbo and jargon. Take these steps every time you want to visit a doctor or have a medical procedure

Want to visit a doctor? Call your insurance company – Do not depend on their website

Yes, CALL your insurance company to verify if the doctor you are planning to use is part of the insurance company’s network of preferred provider. Most likely insurance company’s website is not up to date, so make sure to make that call. It is also advisable to call your doctor’s office and ask for the Tax ID they are using to bill your insurance company. Use that Tax ID to verify if your doctor is part of your insurance company’s preferred network of providers.

When you make that call with your insurance company, ask for a Reference Number at the end of the call since most insurance companies track their insured call and some even record it. Use that reference number to dispute any charges that are different to what you were told.

Key Take away: Call your doctor, ask for his/her Tax ID. Use that Tax ID to verify with insurance company if your doctor is part of the insurance network.

Want to have a medical procedure? Taking these steps will save you lots of money and headaches  

You go to your doctor, and he/she referred you to do specific procedure like x Rays, CT scan, etc. After you do that procedure, you discovered it is not covered or partially covered because many reasons like you did not get a pre-authorization, or you the doctor performing the procedure is not part of the insurance company’s preferred network, or the facility where the procedure is performed is not part of the network. Here what you need to do to make sure you do not get a surprise bill from your medical provider:

  1. Ask your doctor’s office for the Tax ID they use to bill your insurance company
  2. Ask your doctor’s office for the CPT Code (Current Procedural Terminology). This is the code that the insurance company uses to know the kind of procedure your doctor is requesting
  3. Make sure that the doctor performing the medical procedure and the facility where it will be performed is part of the network. Yes! You might have the procedure covered but the doctor performing the procedure is not and vice versa is also true.  
  4. Ask your insurance company if the facility where the procedure is performed is considered as a standalone facility or is considered as part of a hospital. Do you know why? Because if it is part of a hospital, you will be getting a surprise bill for using the facility such as a hospital. It is called Facility Usage. If this happens, your insurance will most likely treat it as part of co-pay, not deductible. In plain English, that means you end up paying the whole bill since most likely you haven’t reached you max Co-pay limit.
  5. Ask you insurance company how you would expect to pay for that procedure based on your insurance plan benefits.
  6. Make sure to ask for a Reference Number for your call with the insurance company as a proof that you called and verified all the information you needed to make sure you are using in-network provider like a good citizen.  

Key Take away: Call your doctor, ask for his/her Tax ID. Use that Tax ID to verify with insurance company if your doctor is part of the insurance network. Ask for CPT Code for the procedure to be performed. Make sure the doctor performing the procedure and the facility used are all part of the network. Make sure you understand how the facility is designated by the insurance company as a standalone facility or part of a specific hospital.

IADE Copyright 2021