Tips for Dealing With Insurance Companies in a Medical Emergency

Medical emergencies can happen at any second. It's vital to not only have health insurance, but also to have an overall understanding of how to reach out to your insurance company when issues arise.

Here are some tips on how to work with insurance companies during a medical emergency and after.

Out-of-Network Services (aka Ambulance Services)

Ambulance services are infamous for not being fully covered by insurance. They're kind of a wild animal in the insurance game since 99% of the time you're not able to choose that ambulance service that comes to you (for obvious reasons) and they're often out-of-network. With ambulance providers billing in the thousands of dollars and insurance only paying for a fraction of the bill, it leaves you with the brunt of what's owed.

Reach out to a benefit resource center through your health insurance company's broker (for UnitedHealthcare, for example, it's the USI Benefits Resource Center) that could potentially help. Brokers like USI speak insurance and can connect you directly with your insurance company and advocate for you when it comes to any of the following:

-- Any claim questions/issues.

-- Filing claims for out-of-network services (for instance, ambulance services by sending a claim back to the insurance company's claims department).

-- Claim escalation, appeal and resolution.

-- Understanding bills from providers.

Also, if you or a loved one is currently at a hospital and needs to have further ambulance services, ask your insurance company for a list of in-network providers within a 10 to 20 mile radius. Provide this list to your case manager. No ambulance service should ever be out-of-network if the transport is not an emergency.

[Read: How to Negotiate Your Medical Bills.]

In-Network Services Becoming Out-of-Network

This sometimes happens -- for instance, when it comes to having surgery and your anesthesia provider becomes out-of-network (e.g. U.S. Anesthesia Partners and UnitedHealthcare). Or when your PCP becomes out-of-network after you saw them in clinic. If your bill shows that insurance didn't pay for their share, call immediately.

Your Employer's HR Manager

Along with a broker, a key advocate during an emergency is your employer's HR manager. This individual likely has direct contact with a broker that can connect with your insurance company's higher-ups. This broker can reach out to the higher-ups when it comes to plan coverage issues (for instance, appealing a denial of requested services like inpatient rehab).

[See: Top Health Insurance Companies]

What Are Their Phone Numbers? Is There an App for That?

On your phone, add as favorites your broker's and insurance company's phone numbers. On top of that, download your insurance company's phone app so that you have easy access to all pending and posted claims. If something seems off, get ahead of the problem and call your insurance before the bill even comes in.

Avoid That Surprise Bill

Let's say you're in need of home health services, outpatient therapy or equipment. Ask your case manager to reach out to your insurance with the billing codes they'll be submitting to ensure what's being requested is covered and at what percentage. This helps tremendously so there are no surprises on your end if the case manager decides to throw in something that's not covered and you get a surprise bill. In short, become friends with your case manager and know what's going on.

If You Get a Surprise Bill

Often, your plan will cover services rendered. There are times though a certain specialist might be brought in during a surgery that might not be in-network, or a certain drug was used that might not be covered by the plan. Those charges will be directly billed to you since they were not covered, but that doesn't mean you can't ask your insurance to cover them (for the full amount or partial).

[Read: Tips for Navigating Medical Care Without Health Insurance.]

The health insurance game can be really confusing and frustrating, and that's OK. Hospitals are sometimes forgiving when it comes to bills, and you can occasionally "negotiate" to lower the bill (e.g. inability to work) or ask to be put on a payment plan. In any case, be proactive when you're able to, and have family and friends help field incoming bills.

Ton La, Jr., JD is a fourth-year medical student at Baylor College of Medicine. He graduated from the University of Houston Law Center in December 2020 with a focus on disability law and bioethics law. He completed a legal externship at MD Anderson Cancer Center, advocated for COVID-19 high-risk inmates, and was a Juvenile & Children's Advocacy Project volunteer lawyer.

His passion lies in Physical Medicine & Rehabilitation (PM&R) with interests in brain injury, spinal cord injury, pediatric rehabilitation, and sports medicine. He is applying to PM&R residency programs this fall. He also addresses the social determinants of health through action, leadership, and writing.

His written works for Doximity, KevinMD.com, MedTruth, and The New Physician (TNP) garnered thousands of reads and social media shares. His writing focuses on today's hot button health issues, patient stories, advocacy, mental health, advice to medical students, and more.

He has held numerous leadership positions, notably as a Student Ambassador at Baylor College of Medicine, Student Editor and Founding Member of the Omentum Literature and Arts Journal, and the Facebook Lead Administrator for GetUsPPE.org. He also served on the American Medical Student Association Board of Trustees from 2017-2020 as TNP Student Editor and as the Vice President for Membership.

He is a Summa cum laude graduate of the University of Houston. There, he is a co-founder of the first Texas public university Campus Kitchen Chapter where he helped win $10,000 in seed funding by competing at the Clinton Global Initiative University through the Resolution Project Social Venture Challenge at the University of Miami and through competitive grant proposals. At UH, he was one of ten U.S. students, selected out of 300 applicants, to participate in the commemorations of the 70th anniversary of the Battle of Normandy in France.

Prior to entering medical school, he was awarded the President's Volunteer Service Award for his 1000 hours of service in volunteer and leadership capacities at Texas Children's Hospital and Baylor St. Luke's Medical Center.

Outside of academics, he is a pianist and 3rd degree black belt and instructor in Taekwondo and Hapkido. He loves weightlifting, boxing, uploading to his YouTube channel, Samoyeds, and picking out his next succulent. To learn more about Ton, connect with him on LinkedIn.