The MLRA Therapy Blog

Insights and ideas from the therapist team at Meghan L. Reitz and Associates.

Why Insurance is Hard to Deal With

Is it me or is health insurance a bear to deal with?

This is a question that I often ask myself both from a personal and professional standpoint. It isn't you, it's them. Not to sound like a cliche, but you aren't going crazy. Healthcare, insurance, managed care- it is difficult to understand the in's and out's of the following:

  • Your benefits
  • How your claims are processed
  • If your claims are processed correctly
  • How to see practitioners in-network vs. out-of-network

I wish that I had been taught this in my graduate work when becoming a healthcare practitioner. Unfortunately, we have to go through a lot of trial and error before really grasping all the above issues. So, let's talk about how to cope with understanding your benefits, what should be expected of you from your insurance and your healthcare providers, and how to advocate for yourself.

1) Benefits: It's important that you work closely with your Human Resources, employer, or whoever manages your healthcare benefits. If you are self-employed or using the Affordable Healthcare Act insurance, you should make yourself familiar with what premiums you are paying and what your benefits include. Remember that medical benefits can be/often are different from your mental health benefits. Call your the 800 # on the back of your card, get a listing from your HR, or sign up online for your health insurance portal to familiarize yourself with copays, coinsurance, deductibles, and out of pocket max's. 

2) Expectations of Insurance/Healthcare Providers: Often you will have what's called a deductible which means you must reach a certain dollar amount before insurance will actually kick in and start paying. That means you will typically have to pay out of pocket for all services until this deductible is met. Make sure that before you make an appointment or go to a hospital, find out if they are in network or out of network. Rule of thumb is that it will cost you less to see someone in network. You will also want to make sure you understand what payment will be needed up front if you do indeed have a deductible. It is also important that you follow what's called your EOBs or Estimation of Benefits. This will help you understand what practitioners are billing for, how much you might owe, and where you stand on things like deductibles and out of pocket max's. 

3) Advocate: No one will fight your battles with insurance accept for you. That is the hard and brutal truth of it. Be sure to document any time you call your insurance company with date, time, and who you spoke to. This is extremely helpful if you need reference it in the future. Keep track of your deductible and out of pocket max's by keeping up on your EOBs or signing into your online portal. Don't be afraid to ask questions- and you can always ask for a supervisor if you aren't getting the answers you need with your insurance company. If your insurance is through your employer, they can also help to advocate for you if you are having difficulties.

As this is just a glimpse into how insurance works and how it can be a bit frustrating, more blogs will be written with more in depth ways to keep up on your understanding of your benefits and out of pocket costs. If ever in doubt, talk to your practitioner/provider/hospital, and they can often help you out on their end too. If nothing else, don't get discouraged. Document, document, document AND ask questions whenever/wherever needed.

8 comments (Add your own)

1. wrote:
I all the time emailed this webpage post page to all my
contacts, since if like to read it afterward my contacts
will too.

Thu, May 9, 2019 @ 10:01 AM

2. wrote:
If some one wants expert view about running a blog afterward i recommend him/her
to pay a visit this webpage, Keep up the pleasant work.

Thu, May 30, 2019 @ 11:51 PM

3. wrote:
It's actually a nice and useful piece of info. I'm happy that you just shared
this helpful info with us. Please keep us informed like this.

Thank you for sharing.

Fri, May 31, 2019 @ 3:58 PM

4. wrote:
Hello there! This post couldn't be written any better! Looking through this article
reminds me of my previous roommate! He always kept talking about this.
I will send this information to him. Fairly certain he'll have a good read.
Thanks for sharing!

Mon, July 15, 2019 @ 9:16 AM

5. wrote:
I used to be able to find good information from your content.

Tue, July 16, 2019 @ 9:11 AM

6. wrote:
Hi there, I desire to subscribe for this website to take hottest updates, therefore where can i do it please help out.

Fri, July 19, 2019 @ 5:21 PM

7. wrote:
whoah this blog is fantastic i really like studying your
articles. Keep up the good work! You know, a lot of individuals are hunting round for
this information, you could help them greatly.

Wed, August 14, 2019 @ 6:07 PM

8. wrote:
Thank you for the auspicious writeup. It in truth was a amusement account it.
Look complex to more added agreeable from you!
By the way, how could we keep up a correspondence?

Mon, September 16, 2019 @ 4:07 PM

Add a New Comment


Comment Guidelines: No HTML is allowed. Off-topic or inappropriate comments will be edited or deleted. Thanks.

Share This:
RSS Feed
Take the Next Step: Make an Appointment