A How to article
How to Avoid Surprise Medical Bills
It can be a shock to receive an unexpected medical bill for treatment that you thought your health plan covered.
Many coverage denials can be avoided by following these four key steps:
- Â Stay “in-network.” Most denials occur because patients use providers who are out of their plan’s network for their care. Before you even make an appointment, always confirm that your providers, hospitals and other medical facilities are “in-network.”
- Get appropriate pre-approvals prior to receiving services. Check to see if your plan requires a pre-certification, pre-authorization or referral for services to cover them.
- Double check that your information is complete. Make sure your personal information including your name and health insurance number is correct on the paperwork.
- Understand frequency limitations. Benefits for certain services such as mental health counseling, may have limitations for the number of visits that will be covered by your insurance company.
Questions about a denied claim?
For those who are enrolled in Kaiser or not on our News Corp healthcare plan, Personal Health Advocate who can help you sort it out to get the bill reprocessed for payment. They can…
- Look for duplicate billing. For example, a medication may have been billed when it was prescribed and then again when it was administered.
- Check for incorrect coding. The treatment or procedure code may not match the diagnosis code.
- Address lack of preauthorization. If your doctor ordered an MRI, they can work with them to obtain the proper authorization to get the claim paid.
- Obtain proper documentation. Some bills are denied because the insurance deemed them not medically necessary. They can work with the doctor to get any required paperwork that may be needed.
- Review for data entry errors. They’ll check that your current health policy was entered correctly and look for typos.
Eligible employees, spouses, dependent children, parents and parent-in-law can use this benefit!!!
24/7 Support at 866-695-8622 or online at HealthAdvocate.com/members