We all know that it's difficult and frustrating to try to navigate the insurance system. But when you're dealing with more than one insurer at a time, the process becomes downright mind-boggling. For example, if you're injured in an automobile accident, you must deal with your auto insurer, the other driver's auto insurance company and your health insurer to determine which policy covers basic medical services. Since it's so time-consuming to keep track of everything that an insurer may want or need, many people give up and don't get the services and benefits to which they are fully entitled. To get all the insurance benefits that are due to you…
Create a master list. Before you ever have an issue, it's good to have a master list of phone numbers, policy numbers and other relevant information for all the insurance policies you own or under which you are covered. You would be amazed to learn how few people have such a list. The list may include a private health insurer, Medicare and Medigap supplemental insurance (private insurance that helps pay for what Medicare doesn't fully cover) or Medicaid...long-term care insurance...specific disease-type insurance (such as cancer or heart disease insurance policies).. and any other applicable coverage, including auto and homeowner's insurance. Keep the list current by writing down the policy number... the date the latest premium was paid Gif applicable)...the name of the insurance agent Gif there is one)...and the phone number you should call if you have a question or need to make a claim.
Secrets to success on the phone. When calling any type of insurer, one of the more frustrating problems is being put on hold or being transferred from person to person. I have found that the earlier in the day you contact an insurer, the shorter the hold time. I have also found that hitting the numeral "0" on the phone will often switch you to a live person when you're stuck in recorded messages. Always ask for the name of the person to whom you are speaking and his/her direct phone number in case you get cut off or need to call back. This may sound basic, but most of us never ask for the representative's name. If your call is being transferred, ask the name of the person to whom it is being transferred and if there is a direct line to that department. If the person refuses to give you a name or number, insist on speaking to a supervisor.
Also helpful: If you still don't get answers to your problem, call the headquarters of the company and ask to speak to the customer-service director. If you cannot get through, ask for the president's office and ask whoever answers to help resolve your problem.
Play "hardball." Every private insurer is regulated by state insurance departments. If you have a disagreement about what should be covered or how you are being treated, call your state's insurance department (check your phone book's government listings) for details on how to file a complaint or an appeal. This is sometimes the best way to fight for all the benefits you deserve.
Interview Your Doctor for Better Health Care
Back in 1982, when my wife was pregnant, D we interviewed two prospective obstetricians. Neither one had ever been asked for such an "interview" appointment. Things have now changed, and interview appointments are increasingly common. It's a great way to help you and the doctor better understand your medical situation before you have a crisis. If you're looking for a doctor you will use regularly (such as a family doctor) or one you will need for a major health problem (an oncologist or cardiologist, for example), I highly recommend such an appointment. How to get the most from your interview appointment…
Create a "short list." An interview appointment should be the last step in your search for a doctor. First, make a list of prospective doctors from recommendations of doctors or nurses you already use or friends you trust who have similar conditions. Call each prospective doctor's office and ask the receptionist for general information such as office hours, what insurance plans the doctor accepts and the hospitals where the doctor has privileges to practice (ideally, the best ones in your area). Then check with your state's medical licensing board on the status of each doctor's license or complaints filed. To find your state board, go to www.ama-assn.org (click on "Education & Careers," then "Becoming a Physician," followed by "Medical Licensure" and "State Medical Boards"). This should help you narrow your list to two or three doctors.
Ask for the time you need. When you call to set up your interview appointment, tell the receptionist that you want to spend 15 to 20 minutes with the doctor to find out if this is the right practice for you. Most doctors today will make such appointments, but you will most likely be charged. Insurers usually cover all or part of the cost for this visit. Be prepared for an appointment after normal office hours when the doctor is less rushed. If the doctor is not willing to meet, look for one who is.
Question—and observe. This is not a standard medical appointment, so you are not going to be examined. Write down your questions, but also try to simply have a conversation. Your purpose is to see whether you and the doctor are on the same wavelength. For example, if you are a vegetarian and/or take vitamins and other supplements, find out the doctor's views on those practices. If you have a particular medical problem, such as diabetes or heart disease, discuss his/her treatment approach-for example, does he believe in focusing on diet, medications or both? Who will he refer you to if he is unavailable? The doctor's style and demeanor also are important. Does he answer your questions and look you in the eye? Does he seem bored during the interview? Is the doctor someone you feel you can trust with your health problems? When the interview ends, you should feel that you and the doctor can be equal partners in your care—he has the expertise, but you will have the ultimate decision-making authority.
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