Insurance

A Simple Trick To Understanding Your Medical Insurance Policy

medical insurance policy tips, understanding your medical insurance policy, tricks to understand your medical insurance policy

Sometimes it seems like a special degree is required to dissect and interpret today’s ever increasing insurance policies. One might think they understand what’s covered, and what’s not or how to proceed with treatment to get the maximum medical insurance benefit but then find out they completely missed the mark understanding how their coverage works. My wife and I learned this lesson recently, but fortunately we also discovered a way to help us navigate the confusing waters of insurance coverage.

Concept: Redundant Information Gathering

The word redundant might leave you with the impression we’re just simply wasting time, but that may not necessarily be true.  Let me give you an example.

My wife and I had questions about how our insurance worked in a specific scenario we were encountering, so my wife dialed up the customer service number and put the call on speaker phone. She asked questions and had the conversation with the representative. Once or twice I prompted her to ask an additional question. When the phone call was over, we discussed the outcome. Even though we had listened to the exact same phone conversation we disagreed regarding the true meaning of some of the information.

I then made a followup call, again putting the representative on speaker phone. I asked questions clarifying our disagreement, as well as confirming what we thought we already knew. When I hung up the phone, we again discussed what we had heard. After the second call, we were in agreement, and we believed the confirmation questions asked solidified that we knew exactly how to go forward.

This is just one method of what I call redundant information gathering with the goal of double checking that the information is accurate and fully understood. There are several methods of this technique:

  • Two People Same Information : This is the method I described above, in which two people listen to the exact same information. If two people have to agree on the interpretation of the information, there’s a better chance they understand what it really means.
  • Two People Separate Information : A slight swizzle of the first method, here both people would call separately to try to answer the question at hand. After the first phone call they compare information. If they agree, then they can move forward. If they disagree, or questions remain, another round of phone calls is made.
  • One Person, Multiple Calls : This is a way by one person can increase the probability that they have accurate information. By making two different calls, and asking the same questions, the hope would be the insurance company gives the same information both times. You’d be surprised at how often that is not the case.

Insurance policies are complex, and sometimes people interpret policy language or the answers to questions differently. Other times, customers could simply be given incorrect information from insurance company representatives. By following one of these methods, customers can increase the probability they have the right information, understand their insurance policy, and know exactly how to proceed and what their cost will be. It may may take a bit more effort, but with the amount of money that could be at stake, it just might be worth it.

Brought to you courtesy of Brock

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About the author

Brock Kernin

2 Comments

  • Interesting conversation. I have been in medical insurance for over 20 years, used to be easy to understand and to the point. Now the policies are filled with legalize and interpretation. I sometimes have to call Blue Cross, Humana, Aetna, etc. when interpretation can be questionable based on circumstances. When I call I often get incorrect information, sometimes I get questionable information. God help me when I get India, Thailand, etc. I often call back several times and get different information from different reps but I know enough to know who is correct and who isn’t. We have a saying” everyone learns their insurance policy one claim at a time” because even when you get what is exact and correct information, a doctor or hospital will code the claim so the information we know is correct is no longer correct. No matter what the policy says the claims are paid when they come in as providers code, and believe me they know how to code to make the most $. Often then I appeal for my clients and often win. Sometimes I fight with the providers to have the claim re-coded. It’s a game. No matter what you hear, coding is how it is paid. Providers use some “creative coding”. Just saying, even though you both agree……

    • “Learning their policy one claim at a time”….LOL that’s awesome. You bring up a good point though, many people may not realize that they can actually appeal their claim and even ask their provider to recode the procedures in their claim.

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