An insurance elimination period is a period of time between when an individual receives a medical diagnosis and when medical expenses related to that diagnosis will be covered by their health plan. As such, it’s important for anyone with health insurance to understand how to survive an insurance elimination period and what to anticipate during one. This guide provides an overview of the steps to take to survive an insurance elimination period and details the most important tips and tricks to employ.
What Is an Insurance Elimination Period?
An insurance elimination period is a predetermined length of time – typically ranging from zero to 180 days – that an individual must wait before their health insurer will pay for medical expenses related to a new condition or procedure. During this period, the insured must pay all associated medical bills out of pocket and will generally have to provide evidence of this expenditure as documentation to their health insurer before being reimbursed.
Importance of Preparation
Since any medical expenses incurred during an elimination period will not be covered by insurance, it’s important to prepare and plan accordingly. The following tips can help individuals to better prepare for their insurance elimination period:
• Gather information: Read through your insurance plan’s paperwork and research the medical expenses associated with the condition or procedure in question.
• Calculate costs: Determine the approximate total cost of treatments, prescription medications, and other medical expenses.
• Budget wisely: Allocate a certain amount of money each month to cover these expenses.
• Allow for the unexpected: Leave some room in your budget in case sudden or unexpected expenses arise during the elimination period.
• Look for discounts: Speak with your doctor or pharmacist about any available discounts or other money-saving strategies.
• Price shop: Whenever possible, shop around for the best deals on treatments, prescriptions, or medical supplies.
• Establish an emergency fund: Establish an emergency fund to cover any deductibles.
• Have a backup plan: If additional funds are not available, create a backup plan in case bills cannot be paid.
Understanding the Process
In order to survive an insurance elimination period, it’s important to have a clear understanding of the entire process, including the following elements:
Timeline
The timeline of an insurance elimination period differs depending on the type of insurance policy. As a general rule, the elimination period begins as soon as an individual is diagnosed with or receives a medical services for the condition or procedure in question. The elimination period ends after a specific period of time as outlined in the insurance policy. At this point, the insurer begins covering any medically necessary treatments and prescriptions required to care for the diagnosed condition.
Reimbursement
Usually, the insured must pay their medical bills upfront and then submit documentation of the transactions to their health insurer in order to be reimbursed. Once the documents have been reviewed and approved, the insurer will reimburse the insured for the medical expenses incurred during the elimination period.
Navigating the System
Navigating the insurance system during an elimination period can be challenging due to its complexity. Consider the following tips to help better understand the process and to ensure that reimbursement is received in a timely manner:
• Stay organized: Keep all relevant paperwork – including policy information, doctor’s notes, and receipts – in a secure location in case it is required for reimbursement.
• Familiarize yourself: Read through your policy information to ensure you understand all of its details, such as how to submit a claim for reimbursement.
• Follow-up: Contact your insurer after submitting a claim to ensure it is being processed and to check on its status.
• Appeal: If a claim is disallowed or denied, appeal the decision.
• Pay attention to deadlines: Make note of all filing deadlines for reimbursement requests to ensure that all are met.
Maximizing Reimbursement
In order to maximize reimbursement, individuals should ensure that they follow the steps outlined below:
• Substantiate expenses: Carefully document all expenses in a comprehensive way and ensure that they are supported by evidence, such as receipts.
• Double-check claims: Carefully review all claims prior to submission to ensure they are complete, accurate, and that they include all required paperwork.
• Follow insurer instructions: Follow the policy and all instructions provided by the insurer exactly in order to ensure that all paperwork is properly handled.
• Consider overpayment: If a claim is overpaid, contact the insurer to discuss the refund process.
An insurance elimination period can be a stressful process due to the financial strain it can create. However, understanding and preparing for one in advance makes the experience less intimidating and helps to ensure that proper reimbursement is received. By reading through the policy information, budgeting accordingly, and utilizing the tips outlined in this guide, individuals can survive an insurance elimination period.
