How to Avoid Being Cheated by Health Insurance Companies


Navigating health insurance claims can be a tricky business. There's a lot of fine print to get lost in, and many people can get the whole process mixed up, leading to them getting smaller pay-outs than they should, or maybe even none at all. Here are some of the most important things to keep in mind to have a problem free health insurance experience.

Do your Research

A clued-up consumer is a safe consumer. Do your research before you decide on a health insurance provider, making sure that the provider you choose is well known and reputable. Many people end up selecting a health insurance plan because of enticing benefits, or because it's the plan that family or friends are already on. Rather compare your options. You may be surprised how much money you can save.

When shopping around for health insurance, be sure to ask questions and request explanations for anything you aren't clear on. Any clause you don't understand and agree to anyway might be the clause that means you don't get paid out.

Don't be Gullible

To protect yourself from potentially unscrupulous people and companies, it's important that you

  • never give out blanket authorization to a medical care provider for bills of service rendered - you never know what they may include
  • never accept offers associated with insurance packages or medical equipment from door-to-door salespeople
  • give your insurance information only to those who have provided you with medical services
  • always keep your healthcare records organised; they may be essential if you ever need to file an appeal

Work-Related Injuries

If you're injured at work, it's possible that your employer will offer you a settlement - particularly if the injury was due to any fault or negligence on the part of the employer. Note that if you take this type of settlement, you may become ineligible to claim for open medical insurance from your employer. Rather don't be fooled by an initial lump sum.

It's also a good idea to have the details of your preferred doctor on file with your employer's worker's compensation carrier. Another doctor may not suit you - and it's possible that a company doctor will be encouraged to play down worker's injuries in order to save the company money.

Use your Insurer's Network

Most health insurers have predefined networks of health-care providers they prefer. Doctors and hospitals in an insurer's network have likely negotiated prices for every conceivable medical procedure. This makes it less likely that there will be quibbles between your health insurer and the medical service providers - and more likely that claims you submit will be settled without problems.

If you use the services of health care providers outside of your health insurer's network, you may be hit with a massive bill with a much higher deductible. So it's always a good idea, when you have the option, to use the facilities and doctors that are in your insurer's network.

Be Patient

If your health insurer hasn't paid out what you expected or your total out-of-pocket expenses are much higher than you believe they should be, you need to use the proper channels to lodge an appeal.

Remember that it's not generally constructive to shout or become agitated when on the phone to a representative of your health insurer. Instead stay calm but be persistent. If the person speaking with you isn't able to provide the information you're looking for, ask to speak to this person's superior. Ensure you determine exactly how to file an appeal and then follow the health insurer's procedure correctly. Failing to do this could make you ineligible to file a second appeal.

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