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Newborn Gallery

January 22, 2018

 

Health Insurance Benefits: 5 Things You Need to Know

 

By Taylor Stonerock, William Newton Hospital Business Office Directortaylor stonerock

Navigating your health insurance claims can be complicated, frustrating, and time consuming. We’ve all been there – a claim denied for missing information, a service you thought would be covered, a provider you expected to be in-network such as a physician’s office or hospital.

Here are five facts you might not know about your health insurance benefits to help avoid delays in payment or those dreaded lengthy phone calls:

  1. Insurance companies can require patient updates. Usually at the beginning of year, insurance companies will hold or deny claims for patient information, such as other insurance information. This leaves the balances to patient responsibility until the requested information is received from the patient. Other times they will require accident information to help clarify the party responsible for a provided service.
  2. It’s helpful to provide a copy of your insurance card to all providers at least once per year. Small changes may occur to your policy information that is essential to the billing process. This will also help your providers keep the most up to date information on file for you.
  3. Some insurance companies do not contract with local providers, or do not consider them preferred providers. Most providers will still accept and bill that insurance, but it can change the out-of-pocket expense for you. If you are considering changing your policy, verify with your providers that they are in-network or contracting providers. If they are not, it could result in higher out-of-pocket expenses for you.
  4. Not all services are covered by your insurance. Some services require prior authorization, and failure to obtain one could result in a denial of services. That could leave the balance of the account to you. Other services, such as oral medication given in an outpatient setting for Medicare patients, are deemed non-covered by the insurance company and are left to patient responsibility. Be sure to check your policy benefits for covered and non-covered service information.
  5. Authorization to speak with family or friends about your claim is required. Be sure to keep your communication form updated with your providers to ensure that you have the correct people authorized in the event that you need someone else to speak with the provider about your accounts.

There is always help available when it comes to questions regarding your insurance! If you are looking to change your policy and need some guidance, the Cowley County Council on Aging is available. Contact them at 620.221.7020. Most providers have staff dedicated to help answer any questions on the billing or processing of your claims.

 

Editor's Note: This article was submitted by William Newton Hospital for the Cowley CourierTraveler Regional Medical Guide published January 27, 2018.