The medical insurance world is fraught with complexities. Most of which involve consumers paying a lot more for their coverage and treatment. There are several common issues that most people will run into – and here’s how to solve them.

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    Out of network

    Out of network, doctors are a real issue, and there is a lot of confusion about the process of choosing the right plan with the right physician. There are many consumers who choose a doctor with an insurance company, only to find they accept patients from one of the other networks. The trouble comes when you go for your medical treatment and end up with the complete bill to pay. So, to avoid this problem, make sure that you search for the insurance carrier, rather than the network. And, if you have chosen an out-of-network doctor, don’t be afraid to ask them if they would join your network, or, if not if they would lower their fees.

     

    No cover

    Some things may not give you the cover you need. For example, if you need drug or alcohol rehabilitation care it can be tricky to get a payment from your insurer. There are many tools that can help you check for rehab insurance cover. So, make sure you use them before booking yourself into an expensive program. Similarly, medication may not be covered. All insurance companies will have a list – or formulary – that will tell you which drugs are covered. Your doctor may be able to request an exception for you if the drugs you need aren’t covered by your insurance.

    High care expenses

    A lot of people choose a plan with low premiums because they need to keep payments in line with their budgets. However, these plans usually mean you will end up paying a lot more for your treatment. Often, they have to meet a deductible of anything up to $5,000 before their insurers cough up – which can lead to serious debt problems. To prevent this common problem, make sure that you weigh up your needs with the plans on offer to you. You may also benefit from seeing a health insurance broker, who can help you with your decision.

    Claim denials

    Claim denials are depressingly common. Insurance companies use a lot of different methods to weigh up a claim, including complicated software. However, they don’t always get it right, and many patients will find themselves with a claim denied and a lot of money to pay out. There is a lot you can do, though. First of all, make an appeal. Appeals are usually looked at a lot more carefully than your initial claim, and in many cases they will be passed through with no problem. Even if you are rejected again, it could be worth appealing again until you do. Statistically, it’s probable that the more claims you put in, the more likely they will pay out in the end.

    Do you have any medical insurance problems you have experienced? We would love to hear about them if you have, so let us know in the comments and join in on the conversation.