Consumer Guide to Health Care
How to Avoid Problems with your Health Insurance
Know your rights, and read your insurance policy (Member
Certificate, Summary of Policy, Summary Plan Description). If you don't have a copy of
your policy, get one from your plan's customer service department or from your employer.
you have a question about whether a particular service is covered, talk it over with your
plan or plan administrator before getting treatment.
Make sure you know when visits to particular specialists and other services need to be
If your doctor asks your HMO to approve surgery or to let you see a specialist who is
not on the HMO's list, check with the HMO to be sure the permission was granted before you
If you have to obtain prior authorization yourself, be sure you do so in a timely manner
and keep a copy of all correspondence and approval forms.
Be sure to know and follow your plan's rules for notifying them of emergency services.
If you have to file claims yourself, do so in a timely manner. If payment of a claim is
delayed, follow up with the insurance company to find out the reason for the delay. This
is particularly important if you anticipate needing more of the same type of services
because a delay may indicate a problem.
If you get a bill you think is wrong, contact your health plan immediately. Do not
wait until you get a collection notice.
Back to the How to Deal with Problems with
Your Health Insurance Page
Last Revised: July 12, 2010