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How to Fight Back With Your Health Insurance Company

Author: David Bakke

When you have an issue with your health insurance company and you think you've been billed incorrectly, it can sometimes be a very long road to get some results for yourself.

However, it can be done, you just need to know how to do it. Utilizing concepts such as "waking up", "fighting for yourself" and so on are good places to start.

And they also require us to practice certain things like standing up to people and things like not giving up.

These things are not easy to do, and I think a lot of us out there decide to take the "easy way out" sometimes. We just let ourselves get run over by people (or companies) rather than fighting for what is rightfully ours.

I have been speaking in concepts and hypotheticals so far, here is the meat of my story. When you see something happening in your life where you know someone is trying to take your money unfairly, or you come up against some company policy that you know is unfair-you need to fight back! You need to step up and do what it takes to get your money back! Or, if it hasn't been taken yet, to keep it from happening.

I will try to be brief and give you just the main facts. Last month, we had to take our son to the emergency room. It turned out to be bronchitis, we just ended up taking him there because by the time we realized he needed to see a doctor, our primary care physician was closed and he needed some medical attention. He is fine now, but we did have to go to the emergency room.

This happened in November and I just got the bill in the mail. The total for all the services performed was right around $1200. Which sounds about right. However, after insurance paid their part, the hospital (or actually, the insurance company) was claiming that I still owed almost $600 of this. Since my son has been born, we have been to the emergency room a time or two and normally after all is said and done, I usually owe about 10-15% of the bill. In this case, I would have thought it would have been about $150. This was calculated just by going by what I had paid in the past.

I knew there was something funny about this bill; I just didn't know what it was. At first, I thought I would just pay it (you see, I almost got lazy myself!) but then again I knew that there was something wrong and I was going to get to the bottom of it and fight like hell before paying out $500 more than I thought I should owe.

After calls to the hospital and the insurance company, this is what I found out (another unfortunate aspect of these things-most situations do involve a little "digging"). My insurance company says that I have a $500 deductible with them with regards to emergency room visits and they said I hadn't met it yet. Technically, they were right. My employer switched health care providers in March of this year, so technically I hadn't met my deductible with the new insurance company. However, like I said, I was certain we had been to the emergency room a few other times with my son in 2009.

After some more digging and some more calls to the emergency room billing department and the insurance company, it turns out that in cases like these, many times, insurance companies will have what is called a "carryover" policy to where in this instance, the fact that I fulfilled my deductible with the old insurance company will still count with the new one.

No one could tell me for sure that this would be the case in my situation, but this is where things stand right now. I keep detailed records of all my son's doctors' visits (for tax reasons and plus, as you can see, you never know when you're going to need them). I got together the records of my son's two previous visits to the emergency room in 2009, complete with where I fulfilled my deductible, and a copy of this most recent bill.

I have emailed the person that deals with benefits at my employer's home office and I'll be faxing all this stuff over to her today. I am fairly certain that I will get $500 knocked off of this bill, and will only be paying around $100. Of course, a lot of things had to take place for this to happen.

I had to be smart enough to realize that this bill sounded wrong (this is called "paying attention").

I had to make the effort to find out what was going on (calls to the insurance company calls to the emergency room billing department, and many, many minutes spent on hold).

I had to already have the documentation handy (my son's medical records, just a step away in my filing cabinet).

Now, I just have to follow up and follow through. My insurance carrier should have this "carryover" policy. If they don't, you can bet that I will still fight for myself. There is a chance I won't win, but I will not go down without a fight. If we were talking about $20, I may not go to this trouble. Considering that $500 is close a full week's work for me, I'd be a fool not to invest the time and effort into trying to get this fixed.

Would you like to learn more tips and strategies on how to impact and improve your personal economy? Visit me at my personal finance blog http://yourfinances101.com/blog

There you can check out my recently published book, "Don't Be A Mule: A Common-sense Guide to Saving More, Spending Less, and Generating Extra Income in Your Everyday Life."



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