Before consenting to a medical procedure or test, it is a good idea to make sure that your insurance policy covers it and negotiate cost if not. Many people simply assume that if a doctor orders a test or procedure, then insurance will cover it. This is a common assumption and could not be further from the truth. Determining whether or not a procedure is covered by insurance is the patient’s responsible. If insurance does cover the procedure, all is well. If not, here is a list of suggestions that may help:

• Ask about alternative treatments: If you are faced with a procedure not covered by insurance, ask your doctor about alternative treatment options. Often time’s insurance may cover a similar test that is just as effective.
• Negotiate with Doctor’s Office: More often than not, doctor’s offices will negotiate price if they think they are better off getting some payment than none at all. Ask to speak with the office manager and explain your situation. According to statistics, around half of those who negotiate with a doctor’s office to reduce payment are successful.
• Appeal to the Insurance Coverage: If you believe that you have been denied a procedure unfairly, ask your doctor for the medical codes related to your procedure and submit an appeal to the insurance company. If turned down, you can still seek an independent review in order to have an independent moderator determine whether or not the procedure should be covered.
• Investigate Clinical Trials: If you have no luck with the other three options, look into clinical trials similar to the procedure you need. If you are approved, the sponsors of the try will most likely pay for all of the tests, procedures, and medications.
• Suggest a Payment Plan: As a last resort, suggest a payment plan with your doctor in which you pay off the cost of the treatment over time.

Being faced with a procedure not covered by insurance is a stressful proposition and one that many people may encounter in their lifetime. Hopefully, these five suggestions on dealing with the situation will help provide a sense of comfort in the fact that you are prepared facing that position. Being denied a procedure is not the end of the world and by taking the advice mentioned here, you can work through the options and come up with the best plan for your particular situation.

Topics of Interest

• Elective Surgery and What is Covered
• Open Enrollment
• Health Reform
• 10 Great Ways to Use Your FSA Dollars