Why I Practice Consumer Law (Part II)

Why I Practice Consumer Law (Part II)

stuckIn my last post, I talked about how the treatment we received from big insurance and big healthcare companies really had us stuck in the mud.

Many other consumers have experienced similar problems with medical bills (for a refresher on our individual situation, see Part I).  Consumers incurred these problems in part because they lacked medical insurance, medical costs increased, and insurance companies refused to cover certain procedures.  The insurance company controls the latter and is arguably the easiest way to boost profit margins.

Studies show about half of bankruptcies are caused in part by medical reasons.  Indeed, many of these consumers had health insurance coverage when their medical bills were incurred.  Unfortunately, it is impossible (for reasons that escape me) to plan all medical care needs and costs.  Some simple strategies can help you when your insurance company inevitably refuses to pay as it contracted:

  • Keep all benefits booklets.
  • Keep notes during insurance benefit presentations.
  • Understand your in-network providers and covered services.
  • Familiarize yourself with the benefits plan definitions applicable to your particular medical procedure.
    • Speak with your insurance company about your procedure. Ask them about the provisions applicable to your situation and to determine what out of pocket expenses you should expect.
    • Take copious notes and keep them.
    • Get the email address of the person you speak with. Send an email to that person summarizing your understanding of the conversation.
  • Provide your healthcare provider with your health insurance information.
    • Ask your provider to confirm benefits with your insurance company.
  • When your receive your explanation of benefits:
    • Speak with your insurance company and your healthcare provider to determine if any billing mistakes occurred.
    • Take copious notes and keep them.
    • Get the email address of the person you speak with. Send an email to that person summarizing your understanding of the conversation.
    • Follow the appeal process provided in your benefits booklet.
  • Stay organized.
  • Be persistent.
  • Contact the Montana Office of the Commissioner of Securities and Insurance.
  • Contact an attorney.

Note these strategies are not in any particular order and may not be applicable in every situation, such as visits to the emergency room, but using these strategies as early as possible could preserve many legal remedies.

Now back to our situation…  Of course, we didn’t follow all the strategies listed above.  I do know, however, following them would have made our dispute with the health insurance company easier.

As if dealing with one of the most honest insurance companies on the planet was not frustrating enough, we were stuck in their timeline.  These disputes take time, and in the healthcare provider’s mind, we owed them large amounts of money and they were going to get that money.  In came the aggressive debt collectors… picture the battle of Falkirk in Braveheart, the scene where the Scottish are battling the English when King Edward the Longshanks orders, “Archers,” and in they come firing arrows at any and all with blatant disregard.  To be continued…


Kay Lynn Lee