Having to go to the doctor’s office
for any reason is bad enough, but it’s all the worse when you run into
frustrating
problems before you even see the doctor. Whether it’s a
cold, flu, or something more serious, the last thing that you want to
hear when you go to see your doctor is
that there is a problem with your
insurance.
Health insurance problems at the
doctors office are not uncommon to the layperson. Most of the time,
many of the issues stem from lack of knowledge about the way your
insurance works and how health care
in America works. But a little knowledge goes a long way and if
you know a few basics before you head off to the doctor’s office, it may make
the trip all the easier.
1)
Health
insurance is not a free pass
That’s right. Having health insurance does not necessarily entitle
you to go wherever you like, whenever you like. Some services that you
may need might not be
covered. And while some offices may take
your insurance, you may be required to be assigned to one particular
doctor in
that office before you can be seen. Call
your insurance company and find out exactly what type you have (HMO,
PPO, EPO,
POS, etc.) and what your benefits are. This
way there won’t be any surprises when you walk into your doctor’s
office.
2)
Don’t collect insurance cards
How many times have you
gotten a new card in the mail and, unsure of
what to do with the old card, you hold on
to both cards in the hopes that
the receptionist at the front desk will
be able to figure out which one is the right one? Here’s a tip:
Chances are the receptionist will not know which is the correct
card. Insurance companies send out new
cards periodically when there is a change in your policy, such as a
rise in
your copay or a change in your member number. If you present the wrong
card, your visit will be rejected by your
insurance company, leaving you stuck with the bill. Save yourself some
time and aggravation,throw away the old card as soon as you get the new
one. You won’t need it anymore. Trust me.
3)
Pay your copay – It’s the law
Did you know that it is actually against the
law not to pay your copay
upon leaving your appointment? If
you think about it, you are paying
your doctor for services
rendered, just as you would a mechanic or your
dry cleaner or anyone else that you request a service for. You would
never just tell your mechanic to ‘bill
you’. It’s no different in a doctor’s
office. They are offering a service
to you and you have to pay once that
service has been rendered. So, be
ready to pay your copay beforehand.
If you don’t know what your copay is, call
your insurance company.
3)
Referrals, referrals, referrals
If you have an HMO,
then you should know that in order to see
specialist,
you will very most likely need a referral from your primary
care physician. You should also know that you will need to
have seen
them for whatever it is that you are
going for in order to see a specialist.
You
cannot call your primary care physician up and ask for a referral if
you’ve never seen them for this problem. It’s fraud, plain and simple.
Also, find out what your office’s
policies are for referrals. Some services
may take several days to be approved
and your office may have to
accommodate for this.
4) Insurance
companies run the show
You probably don’t want to
hear this, but at the end of the day, your insurance has the last word about
everything. The doctor can
recommend the right path to wellness, but at the end of the day, if it’s
not covered by your insurance,
you’ll have to pay out of pocket to have
it, regardless of what service
is suggested.
Mostimportantly, remember that your doctor’s first goal is to help you
get better. So, learn your insurance and save yourself the
headache.