We have heard many clients say, “I have insurance, so I must be covered.” Unfortunately, in many instances, insurance will not cover certain procedures. Some are simply exclusions from coverage. Some procedures are deemed “experimental” or lacking in “medical necessity”. Many problems can be avoided with a bit of knowledge. Each insurance plan is different. Affordable Care Act plans provide some fundamental coverages that “grandfathered” plans or short-term plans are not required to honor. The Affordable Care Act plans do not allow a lifetime maximum that can be spent by the insurer. It is impermissible to impose pre-existing condition exclusions.
 
Only with a better understanding of your health insurance policy, provider billing practices, and your patient’s rights will you obtain more control over the out-of-pocket medical costs you incur. This seminar is designed to enhance your understanding and provide some basic skills regarding insurance utilization and how to deal with medical bills, step by step.
 
Among the topics addressed are:
 
1) Insurance Policy Terminology.
2) In-network vs. out-of-network providers
3) Necessity for pre-authorization (if, when, and how to obtain)
4) Operation of your plan’s drug formulary
5) Invoice Review
6) Explanation of Benefits (EOB) review
7) Insurance Appeals
8) How to research and obtain comparison pricing
9) Whether to use Insurance or Self-Pay
10) The Importance of obtaining written estimates
11) Financial Assistance Review
12) Much more
 
This is offered to individual clients and also, spouses, partners, and family members with similar coverage may attend at no additional charge.