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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.


The following guidelines can help maximize use of a Fee-For-Service (Indemnity) type health insurance policy. Each of the guidlines are discussed in other sections of this article.

Keep Your I.D. Card With You In Your Wallet Or Purse

Your i.d. card identifies you as insured. It may also state the amount of your deductible, co-pay and/or co-insurance.

The card likely also includes an 800 number in case you need to speak with your insurer.

You'll need the information each time you see a new health care provider. It will also be available in case of emergencies.

Stay On Top Of Insurance Company Reimbursements

Originally, the insured was required to pay the bill and then seek reimbursement from the insurance company. Today, most doctors and other providers submit bills directly to the insurance company on the patient's behalf, receive the payment directly, and then bill the patient for the difference between the total bill and the amount received from the insurer. While this practice spares you the up-front hassle of paying the bill and waiting for reimbursement, you still have to keep track of payments and amounts due from the insurance company.

To learn more about bills and indemnity insurance, see: Health Insurance Claims When You Pay Part Of The Bill

For an easy system with which to keep organized, see: Keeping Track Of Your Claims For Medical Bills: A Simple Method

Keep Track Of Out-Of-Pocket Medical Expenses

If your health insurance has a "stop loss" clause keep track of your expenditures so you don't spend more than you have to. Find out from the customer service representative at your insurance company what proof is needed to verify expenditures.

Even if your health insurance doesn't have a stop loss clause, you may be able to deduct the expenses on your tax return.

To Learn More

More Information

Medical Deductions

Avoid Paying Money In Excess Of Usual, Customary And Reasonable

A fee for service insurer will not pay medical expense above Usual, Customary and Reasonable (UCR) for your geographic area.

The company that gathers data that is used in UCR does not make the numbers available to the general public. Even if it did, each company then applies its own formula to the base data.

If you are concerned that your out-of-network doctor or other health care provider may charge more than UCR, contact customer service at your insurance company prior to incurring the expense. Ask how much UCR is for the appointment, test or treatment. Or, to put the question another way: How much does the company pay for the service in your area?

If you and the insurance company disagree, see Arguments To Use Against An Insurer's Denial Of A Health Claim the section titled: A Claim Denied On The Basis That The Charges Are Not Usual, Customary and Reasonable)

Also consider speaking with your doctor about lowering his or her fee.

  • The American Medical Association says doctors have an obligation to compassionately consider the patient's ability to pay.
  • Studies show that people who negotiate fees with doctors are successful at least 50% of the time.
Ask the doctor to accept an in-network fee as if he or she were part of a managed care plan, or accept what Medicare pays. To find out what Medicare pays for the procedure, see offsite link, look for physician's fee schedule

Be An Informed Consumer When Purchasing Drugs, Tests Or Treatments.

If your insurer has a formulary listing approved drugs, ask for drugs that are on the formulary. If there are different tiers of payments depending on whether the drug is branded or generic, ask if an alternative that will cost you less money is available.

When purchasing drugs, balance cost with the other factors that are important to you. To learn more, see: How To Save Money When Buying Or Using Drugs

When a doctor suggests a test or treatment, check around for a balance of the lowest price and quality. While test facilities may not be as used to being asked about price, that should not stop you from becoming an informed consumer.

Balance Premiums, Deductibles, Co-Insurance, Stop Loss, And Benefit

If you have a choice about features of your policy, it's not easy to foresee how to reach the best balance of premium amount with benefits, and amount of deductible, co-insurance and stop loss

You can reduce premiums by  taking the following steps:

  • Increase the amount of the annual deductible
  • Increase the amount you pay as co-insurance
  • Decrease the benefits

If you think about insurance as a way to pay for unacceptable medical expenses, then it becomes clear that saving dollars now to decrease a lifetime maximum becomes really risky.

With a history of a life changing condition, it seems likely that you will incur a basic amount of health care expense each year. You can pay an insurance company to cover those costs. However, trading dollars with an insurance company is expensive. If you pay the medical costs directly, it only costs you $1.00. On the other hand, if you want the insurance company to pay, it will cost you $1.00 plus money to cover the insurance company's overhead, administrative costs, and profit.

The amount of co-insurance that works best for you relates to the amount of the stop loss, which in turn depends on the amount of money that becomes an unacceptable risk to you.

The balance becomes even more difficult if you are part of a unit with a spouse/significant other and/or children.

An experienced insurance broker or financial planner can help you figure out the balance for your life.

Take Advantage Of Discounts And Wellness Features


Check your policy for discounts such as with respect to medications and/or wellness items.

Wellness Features

Health insurance policies these days are likely to include wellness features to help people stay healthy and maximize disease fighting ability.

  • Gyms: In spite of your health condition, there may be a premium discount or refund for belonging to, and/or going to, a gym. (To learn how to choose a gym, click here. To avoid infect ion in a gym, click here)
  • Nutrition: There may also be access to a nutritionist,
  • Complementary Therapies: While it may not be stated in the policy, complementary treatments such as Yoga or meditation may be covered. To learn about complementary treatments, including their benefits and how to find an appropriate professional, click here.For information about specific complementary therapies, including how to find an expert, see:

If You Smoke, Quit.

Premiums for non-smokers are lower than premiums for smokers. It may take a while before the company will reduce your premium

If your plan has high out of pocket costs, see if you can set up a Flexible Spending Account or a Health Savings Account.

If You Need An Unusual Off Label Or An Experimental Treatment

Insurance companies do not generally pay for experimental treatments. 

They may also balk at paying for off label treatments - use of a drug or treatment other than for the FDA approved use. Some off label treatments are so standard that they are not questioned. At the other extreme, the treatment may be so novel that it would be considered to be experimental. There is the whole gray area in between.

If a treatment you desire could be considered "experimental," work with your doctor to create the strongest argument as to why it's in the insurance provider's interest to pay for it. Get agreement form the insurance company before you take the treatment, or be prepared to pay the entire bill yourself.

Consider reviewing Arguments To Use Against An Insurer’s Denial Of A Health Claim.

We also supply a Sample Letter: Experimental Treatment to help provide some guidance.

NOTE: If the insurer will not pay for If money is part of the equation for you, perhaps you can find a treatment for free through a clinical trial or from a pharmaceutical company that manufactures the drug.


How To Change An Insurance Company "No" To "Yes".

Fight for a "yes." Studies show that persistence pays off.

Follow the insurance company's appeal process. Pay close attention to the dates set by the insurance company by which various actions must be taken.

  • For policies issued before September 23, 2010: You likely have a right to an internal and and external appeal. If you policy does not mention external appeals, check the law of your state. You can find the law by contacting your insurance department. Contact information is available at offsite link
  • For policies issued on or After September 23, 2010: Thanks to Health Reform 2010, you have the right to both an internal appeal and an external appeal to an independent reviewer.

To learn about time tested arguments to use, see Arguments To Use Against An Insurer’s Denial Of A Health Claim.

If you need it, get help for the fight. Consider:

  • Getting the help of an experienced insurance attorney.
  • Using all sources of influence. For example, if you have your insurance through your employer, ask the person at the company who deals with insurance matters to speak with the insurance company.
  • Speak with your disease specific nonprofit organization. Perhaps they have information that could be useful.
  • Consider applying public pressure via television, radio, newspapers and/or the internet.

Ultimately you can complain to the state insurance department. It supervises all insurance companies which sell insurance in your state. You can find the contact information for your insurance department at offsite link

You can also start a civil action in the courts.

How To Choose And Maximize Use Of Doctors

Ideally, everyone with a serious health condition should have both a primary care doctor to take care of your overall health, and a specialist who is experienced in your condition.

Studies show that time with most doctors is very limited. There are time honed tips to maximize time with a doctor.

For information, see:

If Your Plan Has Mental Health Benefits, Take Advantage Of Them

Your mental health is as important as your physical health. It can be argued to be even more important in the sense that it is your mental health that helps drive your obtaining the best medical care and adhering to ongoing drug schedules.

A mental health provider can help keep depression and anxiety in check.

Also, if you decide you want to stop work and go onto disability, mental health can be part of a disability determination. In fact, a mental condition such as depression can in itself be considered to be a disabling condition.

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