San Antonio Insurance Blog

Health insurance companies like to keep secrets. And they like to save money. Example: You have surgery, and weeks later you get a bill for using an out-of-network anesthesiologist. Ridiculous, right? You didn’t choose who put you under, so you shouldn’t have to pay extra. But your insurer sent the bill anyway, hoping you wouldn’t notice.

Fighting back against this kind of trickery—and winning—is a lot easier than you think, says Kevin Flynn, president of Healthcare Advocates, a Philadelphia-based firm that helps patients wrangle with their health plans. We checked with Flynn and other insurance-industry insiders, lawyers, doctors, and regulators to uncover nine little-known ways to get the health coverage you deserve—for less.
Don’t pay if you don’t have a say.
When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees. “If you don’t have direct control, you are not liable,” Flynn says, adding that this tack is likely to work every time, but few consumers know about it.

You may be eligible for more coverage.
Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop. One good place to check is Families USA, a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health care advocate for consumers. Another option: Contact your state’s insurance commissioner.

To get tested, talk up your symptoms.
Your insurer doesn’t want to pay for a colonoscopy if it’s not necessary. But if your best friend is diagnosed with colon cancer and you want the $675 test to put your mind at ease, here’s how to get one covered: Mention to your doctor that you’ve had some blood in your stool and a lot of gas lately—or simply that your bowel habits have changed. Your plan has to pay for the test if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)

Stall first, answer questions later.
When Wendy Decenzo became pregnant with twins, she wasn’t worried about health insurance. Her husband, Chris, had made sure to get a health plan that covered pregnancy well before they started trying. But when Wendy began going for prenatal visits, coverage was denied. Their plan, Blue Cross of California, wouldn’t say why. Instead, the insurer asked the Decenzos to sign release forms allowing the plan to view their medical histories, which the law says are private.

Chris believes the company was looking for any info that the Decenzos may have accidentally omitted when they applied for coverage. If an omission were to be found, the couple might have been denied coverage. “It seemed like a fishing expedition in order to deny us,” Chris says. So they refused to sign, and three months later the plan started paying for the prenatal appointments, even going back and paying for earlier visits that hadn’t been covered. Flynn says lots of insurers try this trick, but since their review process usually lasts only 60 to 90 days, they often drop the inquiry after that. Sometimes, procrastination pays.

Letters are your best bet.
It may seem a bit inconvenient, but the old-fashioned letter is by far the best way to communicate with your health plan. “Don’t do anything over the phone. It takes forever and when you’re done there’s no record of it, so it didn’t happen,” says Rhonda Orin, a Washington, D.C.–based attorney and the author of Making Them Pay: How to Get the Most From Health Insurance and Managed Care.

Letters almost always get a response, adds Lembo, the Connecticut health-care advocate. Some plans will answer email, but many won’t. And to whom, exactly, should you address your mail? Experts recommend following your plan’s appeal process for letters and sending copies to your state insurance commissioner. Also, keep copies of every letter you’ve sent your plan and everything they’ve sent back. That way, when your insurer says, “We never said we’d cover that,” you can say, “I have it right here in writing.”

Doctors can be good weapons.
You just got four massage sessions, under doctor’s orders, for lower-back pain—but your insurer refuses to pay for them? Ask your doctor for help. He can tell the insurer he’s going to complain to the state board that regulates health plans.

“Health plans may not fear you, but they do respect the board,” says James Moss, a retired Kentucky surgeon. He intervened on a patient’s behalf and, by pressuring the board, helped the patient win coverage. Another option: Say you’ll call your congressman and/or state Medicare office to lodge a formal complaint, Moss says.

Caveat: Don’t actually contact your state board yourself if a claim is denied. Janice Weiss, a Jupiter, Florida–based attorney who fights health plans for consumers, says some of her clients who went this route ended up hurting their cases when the state agency ruled their claims invalid; that left them little recourse with their insurance companies. Instead, while working your plan’s appeals process, just suggest you may take the matter to your state.

A little research can go a long way.
If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria, says Anne Roberts, executive vice chair of the department of radiology at the University of California, San Diego. Used primarily by doctors but open to the public, it’s an up-to-date list of the types of imaging that are right for various conditions. Arming yourself with the info doesn’t guarantee coverage, but it’s a proactive step in the right direction.

There are ways to get drugs cheaper.
Doctors are often wowed by the latest and greatest drugs, which tend to be the most expensive. Make sure these newer, high-end meds are what you need before you leave the doctor’s office. Sometimes your insurance plan won’t pay for them at all; other times it’ll charge higher co-pays. In many cases, drugs have generic versions that are just as effective but cheaper than the newer ones. Always ask your doc (or the pharmacist) for generics. And if you really need a medicine that doesn’t have a generic version, order it by mail. Many plans have a less-expensive mail-order pharmacy option. Another prescription trick for people who have chronic conditions like allergies: Ask your doc to write you a prescription for two or three months’ worth of medication instead of one. Goodbye, extra co-pays.

An advocate can help you win.
Imagine being turned down for coverage after running up $125,000 in medical bills. That’s what happened to the parents of a daughter with anorexia just before they sought help from Kevin Flynn, of Healthcare Advocates. For $400, he took over the fight with their insurer and—after a year’s worth of combat—won.

Flynn is a patient advocate, part of a growing industry that makes its money from helping you. Some advocates help you interact with your doctor, while others specialize in insurance disputes. Most of all, firms like Flynn’s keep the letters going out on your behalf, saving you time, energy, and headaches. “The insurers know that advocates know the laws, the regulations—things a regular consumer might not know. That makes them nervous,” Flynn says.

Advocates can even get policies changed. One of Flynn’s clients, who had rectal cancer, was having trouble getting his insurance plan to pay for a new radiation therapy. The insurer claimed the treatment wasn’t ready for prime time, but Flynn found six studies showing its usefulness for the disease, got the coverage—and got the insurer to rewrite its policy.

To find an advocate, contact the Patient Advocate Foundation, says Laura Weil, interim director of Sarah Lawrence College’s Health Advocacy Program. Another helpful resource is the Society for Healthcare Consumer Advocacy. Also try checking with the medical association for a particular condition, like the Multiple Myeloma Association or the National Association of Anorexia Nervosa and Associated Disorders; many of these groups keep lists of advocates.

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Getting a good deal on auto insurance is hard enough. Keeping your premiums from rising? That can feel like playing a game where the rule maker refuses to tell you the rules.

Here are a dozen ways the industry works, with tips to help you save:

If you have good credit, you’ll pay less. Almost all insurers — including the top five — pull your credit report. Why? Studies have shown a direct correlation between your credit score and the likelihood that you will file a claim. Insurers also know that if you pay your bills in a timely fashion and have had the same credit accounts for a long time, you’re more stable than someone who pays late and frequently opens and closes accounts. They use this information to create your “insurance risk score,” which is one factor that determines your auto-insurance rate.

Tip: Your insurance-risk score is not available to you, but it may be similar to your credit score. If you have unusual credit activity, wait a month for it to return to normal before buying auto insurance. If your credit history is shaky, clean it up as soon as you can.

Your car model affects your premium. You won’t get these numbers from your insurer; in fact, you may not be able to get them at all. But the auto insurers do have a rating system for every car make and model. Most use a system devised by the Insurance Services Office, which starts with the cost of the vehicle and then factors in safety and theft data. Cars are given a rating from 1 to 27, and the higher the number, the higher your premium.

Tip: Look up your car’s relative risk with MSN Money’s comparison tool. If you’re buying a new car, ask your insurance company about the difference in premiums for cars you’re considering. Search online for the latest top 10 lists on the most expensive cars to insure, and the least.

Pay in full to avoid installment fees. “Fractional premium” fees are usually charged when you pay your annual premium in installments rather all at once. Payments usually are offered on a six-month, quarterly or monthly basis, but almost every insurance company charges an administrative fee for breaking up the payments. The more you break it down, the more those fees add up.

Tip: Ask about fees for paying in installments. If the fees are small enough, it may be worth it. Remember that insurance companies can cancel your policy for late payment, many times with minimal notification, so make sure you won’t miss an installment. If you can pay the premium up front, it may simplify the process and save you a few dollars.

That Pearl Jam CD in your car isn’t covered. Stolen or damaged personal items like compact discs aren’t covered by your auto insurance.

Tip: You can file a claim on your home insurance. Most home-insurance policies will cover smaller, less expensive items such as compact discs. However, if you carry expensive items such as computer equipment, ask about a rider to your home-insurance policy. It’s wise to take photos or video of any expensive personal items before they go missing.

Bad drivers will pay
You’ll pay for your bad driving. The industry standard is to increase your premium by 40% of the insurer’s base rate after your first at-fault accident. For example, if the company’s base rate is $400, your premium will go up by $160. Not all auto insurers play by this rule, though, and some may increase your individual rate by 40%. Regardless of what formula they use, in the majority of cases, your rates will go up.

Tip: Some insurance companies have a “forgive the first accident” policy. The qualifying variables are wide-ranging, so ask your company if it has a forgiveness policy and how to qualify.

You’ll pay for your friend’s bad driving, too. If your friend borrows your car and crashes it, you’ll have to file a claim with your insurance company. You’ll have to pay any deductible that applies, and your rates will probably go up as a result of your claim.

Tip: If your friend didn’t have permission to take your car, in most cases you won’t be held liable for the damage. But if your friend is uninsured and causes damage that exceeds your policy limits, the injured party can come after you for medical and property-damage expenses. Best bet? Don’t lend out your car.

Your car’s real worth
The value of your “totaled” car may surprise you. Auto-insurance companies don’t use the standard Kelley Blue Book or National Association of Automobile Dealers value. Instead, each company has its own proprietary list of car values, and most have specialized software for valuing cars in each region. They take into consideration the car’s mileage and pre-accident condition.

The insurance company may also ask local dealers what they’d charge for a similar replacement car. However, the insurer will consider quotes from suburban towns as reasonable estimates, even if you live in the city. You might have to drive several hours to reach the cheapest dealer, just to save the insurance company money. And they might be quoted a better deal than you could get if you walked onto the lot.

Tip: If you disagree with your insurance company’s value determination, there are several things you can do:

Next time, get “gap” insurance. It will pay the difference between what an insurer will cover and what you owe, which can be several thousand dollars.
If you have maintenance records that show you’ve had the oil changed every 3,000 miles and you’ve had the car checked routinely by a mechanic, present copies to the insurance company to show the car was in good condition. If you’ve been paying premiums on any special parts or upgrades, make sure those are included in the insurance company’s evaluation.
Get price quotes on replacement cars from three dealers within a reasonable driving distance and submit these to your insurance company. Ask the insurance company for a list of dealers within a specific distance who can sell you an equivalent car for the value the company is claiming.
If you still aren’t satisfied, you can step up the process and go to mediation or arbitration. Mediation involves presenting your case to a neutral party for help in reaching a compromise; arbitration is a binding decision. You can also, of course, take the issue to court.

Check into “diminished value.” Say your car has been in an accident, but repaired. Is it worth less than the exact same car that hasn’t been in an accident? It’s a hot topic, but some say yes. In 14 states, you’re allowed to file a claim with your insurance company for that lost value.

Tip: Thirty-six states and Washington, D.C., allow insurance companies to exclude payments for diminished value, so if you live in one of those states, you won’t get to claim the loss. But in Florida, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Massachusetts, North Carolina, South Dakota, Texas, Virginia, Washington and West Virginia, you have a chance of getting a diminished-value payment. If you weren’t at fault in the accident, you often can make a successful case against the insurance company of the driver who was at fault.

You may not owe sales tax on your replacement car. Twenty-eight states require auto insurers to pay for the sales tax when you replace your totaled vehicle with a new or used car: Alaska, Arizona, Arkansas, California, Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, South Dakota, Vermont, Washington, West Virginia and Wisconsin.

Tip: Make the request; don’t expect the insurer to offer to pay upfront. Even in states that do not require sales-tax reimbursement, you should request it. Many auto insurers will not deny the request because the policy requires that they make you “whole,” returning you to where you were before the accident at no cost to you.

The tax will be calculated based on the pre-accident value of your car. If the insurance company values your car at $10,000, and you purchase a new car for $20,000, the tax will be calculated on $10,000.

Odds and ends
Hit by an uninsured motorist? Try to “stack.” Stacking uninsured/underinsured motorist (UM/UIM) coverages means collecting from more than one auto-insurance policy that you hold. Most states forbid this practice, but 19 states allow it or don’t address it.

Tip: Check the language of your policy to see if stacking is allowed.

There are two scenarios for stacking: First, if you have multiple cars on your policy with UM/UIM coverage on each, you can collect the limit of your UM/UIM coverage under as many vehicles as necessary to cover full payment for damages. Second, if you have more than one policy with UM/UIM coverage, even if they’re from two different insurers, you can make a claim under each policy until all your damages are recovered.

You can wait to add your teenager to your policy until he or she is licensed. You are not required to add your teenager to your policy just because he or she has reached driving age. In most cases, you can wait until he or she has a license — or, if you’re in a high-risk insurance pool, a permit.

Tip: Don’t forget to tell your insurance company that you have a licensed teen. If you have to file a claim on his or her behalf, your insurance company is entitled to charge you back premiums from the date your teen received a license.

You must officially cancel your insurance policy when you switch insurers. Your policy most likely states that you can cancel your coverage at any time by notifying the company in writing of the date of termination. However, most people assume that if they decide to terminate the policy at the end of the coverage period, all they have to do is ignore the bill. The insurance companies don’t see it that way. They will send you another bill for the next premium payment, and when you don’t pay it, the company will cancel you for nonpayment. That goes on your credit record.

Tip: Call your insurance agent or the company and let him know you are canceling your policy. Give a specific date, or you may end up uninsured for a period of time. The company will send you a cancellation request. Most often, the form is already filled out and all it requires is your signature. Make sure you read it to check for errors.

You may have to prove to your former insurance company that you have new coverage. And if you’ve financed your car through a dealership, update the dealer on your new insurance information, because purchase contracts often require proof of coverage.

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