Hospital Insurance Gaps Could Make You Sick

You know those extra charges that hotels sneak into your bills, like resort fees, convenience fees, service fees and the like? Well hospitals and their doctors frequently inflict worse ills upon their insured patients. And you could be left holding the bag, and I’d rather not specify what kind of bag I’m referring to.

The problem is worst in emergency situations. Let’s dissect how this happens. If your in-network doctor brings in a specialist, consultant, or other hospital employee who is not part of your insurance network, your insurer may cover only a portion of that person’s fees, or none at all. And when you’re on a gurney in an ER it could be a bit difficult to question their insurance credentials of the gal who just shoved that thermometer into your mouth.

If you are on Medicare, you’re protected against excess fees. But if you have private insurance there are steps to take to protect yourself:

  • Know where to go in an emergency. Make sure the hospital is in your network and inquire as what percentage of ER doctors and medical personnel are in your network. If the percentage is low, look for another facility.
  • If you are to undergo a scheduled procedure, ask your doctor who else will be involved in your procedure and demand in-network providers unless there is an exceptional necessity for an out-of-network specialist.
  • If an out-of-network specialist is required, talk to your insurer well in advance to see if it will cover your costs. If it rejects your request, try to talk with a person higher up the chain of command.
  • If that doesn’t work, wait until you receive a rejection and then file an appeal.
  • If all else fails, you may try asking your state insurance department or attorney general’s office to intercede.

A bit of careful preparation could save you thousands of dollars and ton of grief.

Source: Interview with Elizabeth Ryden Benjamin of Community Service Society, in Bottom Line Personal, November 15, 2014.

 

Auto Accident Insurance Payout Could be Highway Robbery.

Your car is hit by an at-fault driver. His insurance company reimburses you for the loss in value (the diminished value) of your car. And, after the initial trauma, all is once again right with world. Right? Maybe not.

According to the Insurance Consumer Advocate Network (ICAN), if you don’t watch out, you could get run over by some sleight-of-hand tricks commonly employed by insurance companies. Sometimes insurers deny that diminished value is covered. According to J.D. Howard of ICAN, never assume that an insurer’s initial diminished value offer is fair. He says that even a fender bender will reduce a car’s resale value by at least 10 percent even if the vehicle is perfectly repaired, because a subsequent buyer will be afraid of hidden damage due to the accident. In case of a serious accident, the loss can be much greater, even with complete repair.

Fender bender

Auto Accident. Photo-Ryanand lenny

What to do if the at-fault driver’s insurance company balks at paying for diminished value? Well don’t tread lightly. Hire an appraiser to establish diminished value. The ICAN website has a list of DV appraisers (www.ICAN2000.com). If the DV appraiser substantiates your vehicle’s diminished value, you can “grille” the insurer and demand compensation. And don’t forget to include the cost of the appraiser’s services in your claim.  

Sources of the above: The Auto Insurance Rip-off,” Bottom Line Personal, November 15, 2013; and Consumer Advocate Network, ICAN2000.com.

But be aware, if you carry collision insurance and your vehicle suffers major damage, your own insurer should cover your loss and seek compensation for your deductible from the at-fault driver’s insurer. Just make sure that you are reimbursed for the diminished value as well.