Wednesday, September 10, 2008

Insurance Tip: Managing Managed Care

Managing your insurance company can be a huge hassle. Multiple doctor visits, various procedures, changes in equipment, etc can make it difficult to ensure proper payment and coverage for your preemie. Here are some tips to help manage your "managed care."


  • Make sure you know what doctor, procedures, etc. need authorization prior to the visit. If you have an HMO, the restrictions can be quite specific so check in advance of having anything done.
  • Once you know when authorizations are required, make sure you get one! And make sure it is in writing. Our pediatrician is part of a larger HMO group so anytime we see someone outside of the practice we have to get authorization. I keep a copy of all authorizations with me so that I have it available if needed.
  • Don't go to an appointment without one! Some specialists may not realize you need an authorization. Insist that the authorization be in place before going to an appointment or you may be responsible for the full payment of the visit or procedure. Don't back down!

Check your statements:

  • Keep a notebook or file folder with all claims and benefits information/statements. File by provider so you can easily check records for exact payments made or issues involved.
  • If there is a note about non-payment, check to make sure there isn't something you need to do to get the process moving. Sometimes insurance companies request additional information from a doctor and they may not get it in time. Find out the cause and be proactive - call your doctor and remind them to send the files/information.

Procedures, Lab Work

  • Some lab work or x-rays have to be done at certain locations in order to be fully covered. Always follow the "know before you go" rule.
  • Unless it is an emergency, always go to the required lab/location for work to be done. A specialist may not realize you have this requirement so be assertive if necessary and let them know where you need to get work done. You don't want to be stuck with the bill later so a little extra leg work on your part is well worth it in the end.

The insurance category has more posts with insurance tips and advice, so make sure to read it!

And if you have a tip or advice to share, please leave a comment.

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