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5 How to work with your insurance company

Even though most people have had some complaint about their health insurance company at some point, they should consider themselves lucky. Millions of individuals do not have the luxury of having medical insurance in the U.S., even today. If you have diabetes, you will be utilizing your insurance benefits throughout your lifetime. You will need coverage for simple needs such as blood glucose meter strips, diagnostic exams, and, possibly, hospitalizations. Policies and plans vary from person to person, but all insurance companies share certain common characteristics. The best way to have a positive experience with your insurance company is to be well informed. This section is filled with tips that should help.

Do your research. Before choosing a a health insurance plan, research your options well. Make decisions based not just on your health as of today but what you anticipate your needs may be in the future. There may not be a perfect plan, but look at your needs, and the costs and access to services associated with each plan.

Curl up with a good policy. Familiarize yourself with your policy. Even though the brochures and paperwork they give you when you enroll are overwhelming, pour yourself a cup of tea, stretch out, and read every word. It is important to know the rules and guidelines to avoid frustrations later.

Stay in the loop. Read the policy updates you receive at work in the mail and stay current—most policies undergo several changes during the year. It is tempting to toss these updates, or file them in a drawer, but make the effort to read them. Some insurance companies offer special services such as pregnancy information kits, health fair screenings, informational lectures, health information pamphlets, and more. Since you are paying your dues, take advantage of every opportunity.

Know the little teeny-tiny phone number on the back of your card. Call the customer service phone number for questions. This service is meant to answer your questions and help you navigate the health care system. Have your card with you when you call, and be prepared to spend some time on the phone. Very often, the customer service centers use automated voice messaging prompts to guide you to the right department. Make the call on a day when you have peace and quiet (no barking dogs in the background to raise your stress level) and when you have time (not when you have an upcoming appointment in 30 minutes across town). You may be on hold periodically as they route your call—use these minutes to file your bills, dust the living room, or water your plants.

Take it with you. Keep your insurance cards with you, not at home. If you tend to lose things, make a copy (front and back) to keep at home in a safe place—just in case.

Let go of the past. Don’t keep old cards past their expiration dates—you can confuse which card is which. Cut up old cards to protect your privacy before tossing them in the trash. Provide current cards to all health care providers and pharmacies, ideally before your next visit or claim.

Create a file. Keep statements and receipts in a known area. You may need them to work through authorization processes, claims processes, or, yes, even appeals.

Don’t take short cuts. If you wish to appeal a claim, follow the insurance company’s directions completely and within the timeline they require. Trying to skip steps or bypass procedures will decrease your chances of having a successful appeal.

Save the pretty stationery. Use the proper forms when requested to get your paperwork processed quickly and correctly the first time.

Be a pack-rat. Keep copies of EVERYTHING you submit in the mail. Having this backup gives you the opportunity to be prepared in case the insurance company wishes to go over documents with you in the future. If you use a fax machine, choose a fax machine that prints out a confirmation of receipt message.

Take names. Write down first and last names and titles (job titles, not royal titles) of representatives when you talk to them each time. Some organizations are large, so just knowing “Sue helped me” may not be useful if you are trying to resolve a problem with a separate division. Keep a notepad by the phone, and politely ask them for their identity and title each time you talk. Add the time and date of the call to confirm your records. If you are having problems and need an advocate, contact your State Insurance Commissioner’s Office for advice.

Prepare for open enrollment days. During open enrollment at your workplace, ask insurance company representatives to explain options and provide you with a directory of providers in advance, so you know your choices in terms of physicians, pharmacies, hospitals, diagnostic centers, etc.

Beware of “outsiders.” If you are going to use a provider who is “outside” of your preferred providers, find out in advance how you’ll need to process your claim if your plan will provide partial payment. In addition, some insurance companies partner with specific blood glucose meter companies for better pricing—if you use the preferred meter, you may save some money. Be cautious about taking free meters at health fairs, though, as your insurance company may limit your choices in terms of coverage for strips. Many times out-of-network providers/products will mean out-of-pocket payment from you, up to 100% of the charges. Terms for these providers/products are provided in the policy statement—the little booklet you were supposed to read.

Pre-authorization means pre-pare. Ask your health care providers to perform and complete pre-authorization or notification requirements in advance of appointments and procedures.

Making transitions. Update doctor’s offices, pharmacies, and other health care providers when you have a name change, phone number change, address change, or policy change. In these days of cell phones and work transitions, many people change numbers frequently. If you make a change, notify everyone.

Start Monday mornings. Plan ahead—make inquiry calls as soon as you can. Ideally, call the first of the week, as it may take a day or two to get the information back to you.

Check with new doctors. If you are thinking of changing physicians or pharmacies, check with them to see if they accept your insurance before you make the move.

Know your generic drugs. Remember which drugs are likely only covered as generic versions on your medication policy so that you are not surprised by substitutions. If you must have the trade-name version, find out what you need from your physician to justify the extra expense. If not approved, you will likely have to pay a higher co-pay for trade-name versions.

Renew early. Renew prescriptions BEFORE you run out. This goes for medications, as well as testing supplies, pump supplies, and other health supplies. Many people obtain prescriptions through mail-order services, rather than the local drug store. These services may take several days to process renewals, so don’t be caught without your meds.

Remember your manners. Be patient when working with others; it may take time for things to be processed. To reduce your tension, ask representatives, “When should I expect to…,” which gives them accountability and simultaneously creates a timeline to go on. Of course, don’t let them forget about you—call back if the call is not returned by the timeline you both established.

MORE RESOURCES TO EXPLORE

MAGAZINES, JOURNALS, AND OTHER PUBLICATIONS

Choosing and Using a Health Plan. Agency for Health Care Policy and Research. U.S. Dept of Health and Human Services; AHCPR Publication No. 97-0011.

BOOKS

The Johns Hopkins Guide to Diabetes—For Today and Tomorrow, by CD Saudek, RR Rubin, and CS Shump. The Johns Hopkins University Press; Baltimore, MD. 1997.

WEBSITES

Agency for Healthcare Research and Quality…… WWW.AHRQ.GOV/CONSUMER/INSURANCEQA