insurance agreed to cover more than contract requires

[JennyK]

I had a GOOD experience with insurance that I wanted to share.

After hitting a maximum liability of $2000 for medical care, my insurance covers medical benefits at 100%. When you're in the hospital it doesn't take long to get there. The problem for me is home health is covered at 50% and it doesn't count toward the maximum liability. Translation is I can be in the hospital at no cost to me, but pay thousands for home health.

I told my insurance case manager that my doctor said I'd be spending 4 of every 7 days as an inpatient if I couldn't afford home health, and that he'd write a letter to them stating so. I requested they increase my home health coverage because staying at home would be in their interest as well as my own. The case manager took it to whomever has the authority to renegotiate contracts and they agreed to cover home health at 100%. My doctor didn't even have to write the letter.

Insurance companies care about money. If you can think of a way they can help you that would save THEM money, don't be afraid to ask. I was shocked at how easy it was. Of course, it had to be a no-brainer when they compared 4 days as an inpatient compared to 1-2 $100 home health visits per week.

[Atsie]

That is awesome. I am so glad that worked out for you. Much nicer to be at home than the hospital!