How to avoid unpleasant surprises with health insurance? (home, bills)

[Nativa]

Hi, I was wondering if anyone could advise on the following. I am relatively new to the US and DC and I need to undergo medical treatment. I chose the doctor (he is affiliated with a certain hospital, where I will also have to do some lab work, ultrasound, etc). The hospital's international department accepted my insurance, the insurance company confirmed my coverage for this specific treatment to me (by email) and to them (by phone), and the hospital is waiting for the official letter of confirmation. The hospital has been dealing with this insurer before and assures me that I am ok. No co-payment is required from me.

the question is: am I good now, can I just relax, or should I be more in control of their billing me - like, ask them what bills they sent to the insurance company, when, if they were covered etc etc, or maybe they will send one single bill once the treatment is completed?
I just don't want to be in for a surprise having to pay the bills my insurance company suddenly discovers it cannot cover.

thanks!

[mettler]

If you ask they will tell you what is covered and what is not. Your insurance company will tell you also

[carthell]

Originally Posted by Nativa

Hi, I was wondering if anyone could advise on the following. I am relatively new to the US and DC and I need to undergo medical treatment. I chose the doctor (he is affiliated with a certain hospital, where I will also have to do some lab work, ultrasound, etc). The hospital's international department accepted my insurance, the insurance company confirmed my coverage for this specific treatment to me (by email) and to them (by phone), and the hospital is waiting for the official letter of confirmation. The hospital has been dealing with this insurer before and assures me that I am ok. No co-payment is required from me.

1) Get a copy of your insurance material, and become familiar with it. Pay attention to the sections where it tells you what to expect when the insurer pays for medically necessary services, as defined by your policy. There is probably a section that also tells you what services it can't cover, and what happens when it can't cover (some of) your medical services.

2) Pay attention to all of the services that may need pre-approval, where applicable. Your insurance material should be able to point this out to you. Make sure that any prerequisite conditions set by the insurance to obtain care are completed before going. Every time you turn over your insurance card for copying in such cases have the clerks write "service needs approval-contact insurance" on the card copy.

3) If you don't understand something, ask questions. Lots of people read or hear something concerning a medical service, acknowledge what was heard or read without true understanding, then forge ahead assuming the fact that an insurance premium was paid means that 100% of a service will be covered.

4) No one will know more about how your policy works than your insurance company. No one. Asking a nurse, tech, or registrar at a medical provider about how your insurance company might pay a bill isn't as authoritative as asking someone at the insurer.

5) Medical services, in general, are billed in parts. Doctors or specialists generate fees when they treat you directly, supervise your care, interpret data from various tests, or consult on your case (when needed). Facility fees are generated to pay for additional support needed by the doctors or specialists (techs, nurses, materials, etc.) to carry out the medical care requested for you. If you bring home specialized equipment not included with the previously-described costs, then fees for the items (commonly known as durable medical equipment) are generated.

6) Don't let what I've written scare you. Millions of people (including me) use health insurance every year without encountering difficulties. Being aware of how your policy works and understanding what services you're going to get will serve you well.

[leighland]

Good that you got confirmation via email. Definitely get anything you can from the Insurance Company in writing so they can't come back at you and say, "We never said/approved that" (that happens).
Chances are if you have no copayments, you have something known as a "Cadillac policy" which means you have a very nice insurance plan that covers almost everything (these type of plans are mostly paid for by very large private corporations or by a federal government entity).
Blessings and good luck with your surgery!

[fortleeresident]

look into any additional departments at the hospital which will be providing you services while you are there, particularly the anesthsiologist. sometimes they are from a different entity and may be out of network when the rest is in network. I would talk to the hospital billing dept and ask them your exact question in advance of the surgery

[Nativa]

Great thanks to everyone! Pre-approval is only needed for hospitalization, which is so far not the case for me.
As for "out of network", for this particular international insurance this notion does not really exist, we are advised to go to certain doctors and hospitals to avoid being billed upfront (then insurance reimburses the costs), but it is not obligatory.
Co-payment is usually required, it is just in my case that I am lucky.
It is just strange that I don't receive any notifications from the insurance company re: my claims (they usually send this info), it has been 4 weeks since my first visit, wonder why it is taking so long...