Every Patient's Advocate

Health Insurance Misinformation Can Cost You!

I received a letter from a young woman (Amanda) with two suggestions for columns. (And let me tell you how much I appreciate those suggestions!)…

The one suggestion that shouldn’t have surprised me, but really ticked me off, was based on her experience with her health insurance company. It’s a heads-up for us all.

Amanda’s doctor was having a problem diagnosing her, and decided to send Amanda for a particular, somewhat expensive, test. Amanda has health insurance through one of the largest insurers in her area, and the doctor’s insurance person called to get permission for Amanda to have the test. The insurance customer service person reported that no permission was needed; that Amanda’s policy covered the test.

Amanda had the test, the results were delivered to her doctor, and they proceded with the diagnosis process.

A few weeks later, Amanda received a bill from the testing center. It showed that they had tried to bill her insurance company, but the insurance company had not paid any of the expense. Amanda called the insurance company to find out why they hadn’t paid for it — and she was told that since she didn’t get permission ahead of time, they would not pay for the test.

She told them her doctor’s office had tried to arrange for permission but was told she did not need that permission. The insurance customer service person told her that was too bad, but in fact she DID need permission, and gee — they couldn’t help it if their people gave her the wrong information. They refused to pay for the test.

Amanda is stuck with the bill now. If she is pursuing it further, she didn’t say. She didn’t tell me what the cost of the test was, but some of them run into the thousands of dollars.

The cautionary tale for all of us, of course, is to double check all the permissions we need. If you think there is any possibility whatsoever that you will need permission for a test or another procedure, then you’ll want to pursue that until you have a piece of paper that says you do — or don’t — have or need that permission.

Understand that the insurance company is the LEAST trustworthy of all the players in your healthcare. One only needs to have the rug pulled out from under her once to know that you can’t trust anyone whose sole raison d’etre is to profit at its member’s expense. Better for us to learn from Amanda than learn the hard way ourselves.

I’ve said it before — follow the money. And make sure to take care of all those loose ends that can cost you out of your pocket, too, when you aren’t paying attention.

	………………..
	Want more tools for sharp patients? Sign up for Every Patient’s Advocate once-a-week or so email tips.
	………………..