Review your health insurance policy and make sure you know coverage limits and exclusions. For example, health insurance typically excludes most dental profit. Understand that if you have a medical condition that result in damage to your teeth, while the medical condition may be covered, dentistry to restore your injured teeth may not be.
Understand your responsibilities under your health plan. Have you chosen a primary care provider (PCP)? Do you need a transfer from your primary care supplier for services and events your PCP cannot provide? Have you received written confirmation that a requested referral has been accepted, or, if you need authorization before a written notice has time to get to you, have you called your insurer to make sure they have certified the referral? Have you recognized with your insurer that the services your PCP has made a referral for are services covered by your health plan?
Keep your insurance ID card handy. Don't hesitate to pick up the phone and call the number on your insurance ID card for support in understanding any part of your policy you don't understand. Call your insurer if you get a bill, a referral, an explanation of benefits form or other document you don’t understand. Other sources of assistance include your insurance agent and your human resources department if your employer provides your health insurance
Keep good files. Know where to find your policy or benefits booklet. Keep copies of any health insurance linked documents you receive from your insurer, agent, human resources department or health care provider in a file you can easily locate. If you call your insurer, agent, human resources department or health care provider regarding an insurance issue, keep a pad of paper handy. Ask for the name of the person you are talking to and make a note of what you discussed, being sure to indicate the date and time of your call.
Know your rights. You have a right to receive a response to a request for authorization of services within two working days. If your insurer denies a request service on the grounds that the requested service is not medically necessary, your insurer must send both you and your supplier a written notice explaining why it believes the requested service is not medically necessary. The notice must advise you of your right to obtain any clinical criteria or information relied upon by the insurer in reaching its decision. The notice must also advise you of your right to appeal the decision. By law you are entitled to appeal any health insurer decision you disagree with. If you lose your appeal, your insurer must sent you a written notice identify the names and credentials of the persons who made the decision and explaining the reasons for the decision. You have the right to the information relied upon by your insurer in arriving at their decision. You have the right to a second level appeal. You have a right to attend and be represented at any second level appeal. If you are not content, you have the right to complain to the Bureau of Insurance.