METIS ADVOCACY

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(818) 576-7032 (fax)

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Insurance Claims

Top 5 Myths About Health Insurance Claims

Insurance companies don't like to pay for your healthcare

Not true.  Insurance companies are obligated to cover all the services in your policy.  They want to pay you for these services otherwise they would be in deep trouble.  It's easier for them to pay you than to deal with appeals and legal hassles. 
 

Insurance reimbursements are final

Just as with medical bills, explanation of benefits (EOB's) can often have mistakes.  It is always a good practice to review all of your EOB's and question anything that does not look accurate.  Only an experienced person can find these discrepancies.
 

All medical services are subject to paying your deductible first.

Usually, one has to meet their deductible before insurance companies will pay towards your healthcare.  But certain preventative services may not be subject to a deductible (e.g., immunizations, cancer screenings, etc.).  It's always a good idea to know which services are paid even before your deductible is met.
 

Health insurance always cover doctor services at an in-network ER or hospital

This is one of the most frustrating problems in the healthcare system.  Even if your ER or hospital is in-network, there is a good chance that some or all of the doctors may be out-of-network (e.g., ER doctors, anesthesiologists, etc.)  It is always wise to understand your benefits before you have a procedure scheduled or before you go to your local ER.
 

All health insurance plans have some benefits for out-of-network services

This used to be true.  But with the popularity of HMO's and EPO's to reduce the cost of insurance, out-of-network benefits may not be available at all.  Please check your benefits before going out of your network. 

 

What We Do:

  • Review Explanation of Benefits

  • Review Policy Benefits

  • Identify Errors and Mistakes

  • Resubmit Claims

  • File Disputes and Appeals