How to Avoid Problems with your Health Insurance

Know your rights, and read your insurance policy (Member Certificate, Summary of Policy, and 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.

If 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 preauthorized:

  • 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 go.

  • 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.

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Last Revised: August 15, 2017