End of the Year Reminders & finding extra money for Holiday shopping!

End of the Year Reminders & finding extra money for Holiday shopping!

With the Holidays rapidly approaching, we are all painfully aware that the end of the year is drawing near. Before you get too busy with Holiday shopping, baking, and socializing, take a moment to make sure you are up to date and ready for year end from a health insurance standpoint.

First of all, have you submitted all your medical claims to the insurance company this year? If not, doing so now may result in insurance reimbursement checks just in time for Holiday shopping! Of course that only applies if you have already paid the doctor bills, if not, please pay your doctor before spending insurance money on other things. Have you reviewed the explanations of benefits to be sure your deductible was satisfied once, and only once? Far too frequently we see insurance companies continuing to apply money towards deductibles after they have been satisfied. If you had a lot of medical expenses, did you hit the “stop-loss” where the insurance company should be paying at 100%? If you find errors in any of these areas – simply call the insurance company and chat with a customer service rep. Plan on calling later in the week, rather than earlier, as wait times are less late in the week.

For many of you, your claims are automatically submitted to your health insurance carrier. But if you have used any out-of-network providers, you may have to submit the claims yourself. You should do this now, if you have not already done so. There is a time limit for submitting claims and that limit depends on your insurance carrier. Many companies will let you do all of the preceding calendar year and the current year. Just as many say one year from date of service. If you have a Medicare supplement with AARP that pays for prescriptions, you have to submit your prescription receipts. AARP will only go back one year.

Review your explanations of benefits to see if you have to submit the claim to your secondary carrier. This is especially important for people with Medicare and “automatic rollover”. Automatic rollover means Medicare will automatically forward the claim (electronically) to your secondary insurer such as AARP or NJ State Health Benefits. However, this doesn’t always happen. If your Medicare Summary Notice (MSN) does NOT have a statement that tells you “this information has automatically been forwarded to your secondary insurer”, you know it didn’t happen. You must make a copy of the MSN and send it to your secondary insurer. The best suggestion is to match up the bill with the MSN, and explanation of benefits from your secondary carrier. This way you can be sure that all carriers paid appropriately, and re-submit claims if necessary.

Are you continuing your health insurance benefits under the COBRA law? If so, be sure to check when COBRA expires. Don’t wait until ‘after the fact’ and learn the hard way that you no longer have health insurance. The same applies if you are continuing your benefits under the NJ Continuation of Benefits law.

And how about the big, thick package you get from your employer at this time of year? October and November are usually open enrollment months, which mean you have the option to switch from one health insurance plan to another that is offered by your employer. The change usually becomes effective January first, but there is a deadline for completing the paperwork. Don’t be overwhelmed by the size of the package. It is usually thick because it may include provider directories for the various health insurance plans from which you may choose. Once you make a choice, you are stuck with it until the following year. The health insurance you select for you family is a very important decision, and not one that should be made lightly. Be sure you understand the plan you select and know how it works.

There never seems to be enough money in December and the temptation to put off paying your health insurance premium will weigh heavily upon you. DON’T DELAY PAYING YOUR HEALTH INSURANCE PREMIUM! You must pay the bill in full, each month, on time, or at least in the grace period to keep your coverage. If it is not received within the grace period, your policy will lapse. Visa bills may hit you with 18% interest for late payments, but health insurance carriers will terminate your coverage. Choose wisely. Unfortunately, in our office, we see the cases where insurance lapsed because “I just didn’t have time to pay bills” and that is when illness usually strikes.

Take an hour this week and just review all of the items mentioned in this article; you may find yourself with extra money within a month but more importantly, you can relax and enjoy the Holidays knowing that these important chores were all taken care of.

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.

* * *