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EDDY & SCHEIN FINANCIAL LITERACY SERIES

Is the Cost of Your Medical Procedure Covered?

Check coverage costs before your medical procedure.

Medical expenses are notorious for blowing the family budget, but with some homework before a planned medical procedure, you might be able to limit the out-of-pocket cost.

An Eddy & Schein Client Story

Regina was given a referral by her gynecologist for a mammogram and an ultrasound. When Regina made an appointment with the radiologist, she was told by the office staff that the mammogram was covered by her insurance plan but the ultrasound was not. Regina questioned this information and was told to check with her insurance company.

Regina did just that. Her insurance company confirmed that not only was the ultrasound covered, but the procedure was not subject to a co-pay or deductible. Regina requested and received an email with a list of her plan benefits, and she made a note of the person’s name and the reference number for the call.

When Regina relayed the details of her insurance call to the radiologist’s scheduler, they said that she, in fact, would not owe anything.

That, however, wasn’t the end of the story.

When she arrived for her appointment, Regina was told by the intake staff she would be responsible for the cost of the ultrasound.

This time Regina was prepared. She confidently stated that she did not owe anything and provided the insurance details to prove it. She even offered the email showing that her policy benefits covered ultrasound.

Regina was proud of herself. Her instincts about the medical charge led her to challenge it and confirm her insurance benefits, and ultimately she did not have to pay.

How to keep from paying what you don’t owe.

Knowing when and how to question a medical expense could save you money and headaches.

Question medical charges if they don’t make sense.

With so many insurance companies and policy variations, even within the same insurer, you can’t depend on your medical provider to know what your copay should be. If it doesn’t sound right to you, call your insurance company.

Do your homework before the procedure.

It’s much easier and faster to verify or correct your copay costs before paying them. Getting reimbursed for payments you made for erroneous charges takes a lot more time, not to mention being frustrating and stressful. Make the call before making your medical procedure payments.

Get documentation.

Take clear and comprehensive notes on all interactions, at every stage, during your conversations with insurance representatives, medical offices, or billing staff. Include any names, phone numbers, email addresses, and call or case reference numbers. You can even request the details of messages your insurance provider sends to your medical provider. Request information in writing whenever possible – via email for expediency.

Stand your ground.

If you experience a lack of communication or receive inconsistent information from relevant parties, be prepared to present your case several times. It may be annoying, but well worth the effort… especially if it results in a lower cost for your medical procedure.

If you’re trying to sort out medical copays and insurance benefits, reach out to Eddy & Schein Group. We know how to help.

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