What is the best family plan you can get?

What can i do if I explained to my doctors office what is covered in my health plan and to not do or request anything beyond what is completely covered, and still get charged $900?

• I have TraditionalPlus hospital plan with Empire, I pay $189 a month or $2268 a year for this terrible hospital plan to cover emergencies and for the 1 annual physical a year for preventative care. I printed out what was covered and not covered based on the material that was sent to me from Empire,I did everything based on what they sent to me, I gave that information to the billing clerks at my doctors office and  told them please make sure that any  procedures/blood work is covered entirely within my policy. I did everything possible on my end to make sure that I would not have to pay for this check up. However I received a letter telling me I owe almost $900 for the uncovered  portion of a routine preventative care blood work that was requested from my doctors office. My question is why is it my job to inform these health care providers on what is covered and what is not? Why is it that I have to go above and beyond to make sure that my doctors office is billing these things correctly? And why is it that after giving them the information that I am still being charged for something that I did not request. I should not have to work so hard just to get a check up, the insurers should be responsible for informing health care providers on what the policy entails, this should be inherited in a health plan, now i have to go and call up the lab, the doctors office, and Empire when I have the time, which i don't and spend countless hours again.. yes again .. to my horror this is not the first time with Empire.

• Answer:

  First of all, I'm terribly sorry that this happened.  I don't work in the medical field myself, but I am related to a health care professional, who deals with insurance companies all the time.  The stories she tells about this stuff is amazing, appalling, and infuriating.Unfortunately, I'm not surprised by your story.      I'm not saying that your information was in any way inaccurate, but lots of the stories I hear involve people claiming their insurance covers certain things they do not.  As a rule, she doesn't really believe the stuff patients tell her about what is covered.  In some cases, it's ridiculous on it's face, like people claiming their insurance covers home health visits for a sprained wrist.  Much more often it's a more grey area. Second, the doctors and other health care professionals are as stymied as you are about what is covered and what isn't.  Sometimes the person at the insurance company is the equivalent of low level tech support and claims stuff is covered when it isn't.  Sometimes it is covered, but the insurance company rejects the claim anyway.  This happens often, and there have been high-profile news stories in the past about some insurance companies rejecting all claims initially to save money.  Third, and again, I have no idea whether this applies to your situation or not, but it's a tough call to ask doctors to make medical decisions based on ability to pay.  It certainly sounds like the situtation you describe is a straight forward one, but I have heard of situations where people decline care based on lack of insurance coverage, then sue the doctor later for malpractice when things don't turn out well.  In America, the unfortunate state of affairs is to overtreat and overtest to avoid legal liability.  As for remedies, I would aggressively challenge the denial of coverage.  Most people don't know that they can appeal these decisions, and I like I said before, this fact saves the insurers a ton of money.