Get to know your health insurance coverage

Published on November 1, 2009

by Angie Hicks, founder of Angie's List

If you don’t already, take a minute to review your explanation of benefits (EOB) statements the next time you incur medical-related charges paid through your health insurance.

According to a recent online poll of Angie’s List members, 30 percent said their health insurance company denied claims that should have paid based on the plan coverage. Another 30 percent have found mistakes in the way their insurance company processed claims, with the most common being errors in coding and the denial of covered services.

It's important to review your health insurance policy so you know what medical treatments are covered and don't overpay if there's a claim or billing mistake.

It's critical to understand your health insurance coverage. Too many of us pay our medical bills without questioning them and we might be paying more than we actually owe. We all need to closely monitor our health care bills and keep a watchful eye out for duplicate charges, as well as charges for services not rendered and other mistakes.

A good rule of thumb is to review each of your EOB statements to ensure your insurer is covering — and not denying payment — for services covered by your plan. Some companies still send EOB statements by mail, but others rely on an online system to view your EOB. If so, be sure your carrier or your employer provides you with the correct access information to view your statements online.

Many of you said simple coding errors on your EOB took months and sometimes years to resolve. Unfortunately, some of you said you just gave up and paid, rather than fight back. The key to successfully challenging a denied claim is to have a firm understanding of what your policy covers and what it doesn't.

According to our poll, more than half of the Angie's List member who responded said they had only a partial understanding or no understanding at all of what is covered under their policy.

To me, purchasing health insurance is just as important as purchasing a house. Policies are complicated and too few of us take the time to read through them and understand how the coverage works. Don't be afraid to ask questions to make sure you understand what your plan does and does not cover.

Billing is such a complicated matter that it's actually created an industry of professionals who help consumers by comparing costs of care, negotiating with insurance companies and answering billing questions. Angie's List recently added a category for these professionals, called patient advocates, and highlighted them in our story about families struggling with medical debt.

Some patient advocates charge an hourly fee. Others work on a contingency basis, and their payment is based on a percentage of what they save their customers. Those of you with large or frequent health care bills might be well served to consider their services.

If you've used a patient advocate, I encourage you to help others by submitting a report.

Bottom line: It's easy just to pay what your insurance company tells you to pay, but do you really want to pay more than you have to? I know I don't.