Research will prevent medical bill surprises

No one wants to learn that their insurance company won't pay a major doctor's bill. What can be done to make sure it doesn't happen?

•Check the fine print for special benefit limitations. Save money and hassle by reading through coverage details, especially the health plan's "exclusions and limitations." Insurance companies often limit coverage for specific benefits.

"Your health plan may limit the number of physical therapy visits you can make in a year," said eHealthInsurance executive Bruce Telkamp. "If you go over that limit, you'll pay the difference yourself."

Health plans may also include a "lifetime maximum," which represents the maximum amount the insurance company will pay for all medical claims in a lifetime. A quality health insurance plan with comprehensive coverage will typically have a lifetime maximum of $5 million.

•Make sure the doctor prescribes only covered drugs. Some health insurance companies maintain lists, formularies, of all the prescription drugs that they are willing to cover with a doctor's prescription. Get a copy of the drug formulary from the insurer and consult it when a doctor orders a new prescription.

•Use the preauthorization or appeal options. Health insurance companies usually only cover services they consider medically necessary. When considering a procedure or surgery, even one ordered by a doctor, apply for preauthorization. This usually involves providing the insurance company with medical records and a letter from the doctor.

This story is provided by North American Precis Syndicate Inc.