Trying to understand health insurance, knowing how to appeal a health insurance claim, and trying to organize insurance paperwork is tough. In fact, we surveyed over 1,000 women who told us just how difficult it is to understand health insurance. We culled your biggest challenges and got advice from leading health insurance experts.
Plenty of folks experience difficulty with health insurance before they even set foot in a doctor's office. 34 percent of survey takers said they have limited understanding of what services their plans actually cover; 35 percent had only fuzzy knowledge of their deductibles, premiums, caps, and co-pays.
When you signed up for your health plan, you probably got a thick packet loaded with policy details— and a lot of jargon. Good news: insurers are now required to send you a straightforward letter, called a Summary of Benefits and Coverage, that lays out in chart form exactly what's included in your plan. Deductibles, out-of-pocket limits, and what's not covered—all are spelled out in language the average human can understand. All summaries follow the same template, making comparison easier. A growing number of employers are offering two or more plans, so summaries are especially useful, says George Boué, an expert with the Society for Human Resources Management.
A note about Explanations of Benefits, those letters that say "This is not a bill": 40 percent of respondents find them unhelpful or never bother to read them. Keep them! They're from your insurer to let you know what it thinks happened at your office visit. Peruse, reconcile with your experience, and cross-check with the doctor's bill. If that's impossible (or one doesn't come at all) call the provider for an itemized bill, says Pat Palmer, founder of Medical Billing Advocates of America.
Many survey respondents seem intimidated by the idea of contacting their insurers:
Luckily, your insurer is available in more ways than ever before. Here are the best ways to contact them:
For many people, health care expenses go well beyond the monthly premiums on their plans. But 39 percent of respondents said they were fuzzy on how much of their hard-earned cash went to out-of-pocket costs in a given year.
In an effort to decrease the cost of co-pays, prescriptions, and other out-of-pocket expenses, some respondents have resorted to iffy strategies:
However, there are several strategies that can help you get the care you need without breaking the bank:
In many cases, medical appointments and procedures are followed by an unpleasant surprise: 30 percent of survey takers said they've been billed for something they believed was covered. And many end up eating those unexpected charges: 57 percent of respondents said they aren't sure how to appeal a coverage denial, and 23 percent of respondents said they've actually avoided filing appeals because the process seems too complicated.
But take heart: Going to the trouble of an appeal is often worth the effort. More than half of all appeals are decided in the consumer's favor, Zamosky says.