I work for a company that offers supplemental health insurance, and thought I'd offer these bits of cheese so that my fellow Kossacs can work their way through the system with a little knowledge.
Occasionally, I'll post little things about the health insurance business. While the company I work for offers supplemental ins., there is some overlap with regular major medical in regards to how they look at claims, deal with problems, and what they offer and don't. This is not meant as a blanket overview that shows how all insurers work, everyone has different procedures, policies, and most importantly, business cultures that determine how they operate.
So, here are some general tips and guidelines. Yes, most seem to fall in the common sense and "Duh!" categories, but you would be amazed at how often these are overlooked.
1) Read your policy thoroughly! Most companies offer open enrollment periods lasting from tow weeks to one and a half months. During this time, you have a chance to fully look at what is being offered for coverage and can hopefully make the best choice for you and your family.
2) Ask Questions! If your company is not forthcoming in providing the information you need, then contact the insurer. There is usually a number to call where we will answer specific questions about the plan we are offering. You can also go to the companies' websites and find detailed info about the policy you are contemplating purchasing. Request a written copy of the plan, along with the basic brochure that is usually handed out. We actually DO want you to sign with us, but we prefer you that you feel comfortable doing so.
3) Please read the enrollment form before filling it out! Folks, this is a legal document. Whether a piece of info being asked seems trivial to you, it isn't to us. There are reasons that the enrollment forms are written as they are-for the protection of both of us. Quite frankly, we do use it to deny coverage to some people because of risk, but it helps you also because we can then process your application and future claims quickly and efficiently. If you don't answer everything, the possibility of being denied is pretty good, or having your claim processed in three weeks instead of three days is almost a guarantee.
So, now that have this little product, let explain a few things that I have learned in this field:
When discussing your health with your doctor, especially nagging aches and pains or particularly, a specific health scare you or a dependent had, request that he not put it in his/her notes. A lot of policies and enrollment forms will ask or state that even the mention of a specific disease or illness some time in your past can be cause for denial of coverage or a claim. A chance remark that you had discussed a possible cancer scare with another doctor or thought you were getting your dad's arthritis a little early can do a lot of damage when filing a later claim if we see it noted in your records. One of the first things we learn is to ask out own doctors to keep certain discussions out of his/her notes.
Before filling out a claim form, read it thoroughly and then call your ins. company to go over your particular claim. There are things that you really don't need to send us, but also things that we do have to actually have. Depending on your claim, we might not need to have a detailed bill from a doctor visit or hospital or a police report, test result, or some such item stated on the claim form. It depends on what type of claim you are filing, injury or illness. We don't need the results of your last STD test if you've only broken a limb, but we will need your biopsy results for a cancer claim, not your hospital bill. Ask us what we need.
Okay, that's all for now. Upcoming, I'll go over what happens when we get a claim in, what we look for, and what you can do if it's been denied, we need more records, etc. I hope that this has helped in some small way.