forms from our health insurance company inexplicably denying payment — or only partly paying — for something we believed was covered.

Hands to Hold When Health Care Becomes a Maze | By ALINA TUGEND | Published: October 13, 2007

I HAVE not dreaded thin envelopes so much since applying to college.

They are showing up with alarming regularity lately: forms from our health insurance company inexplicably denying payment — or only partly paying — for something we believed was covered.

We read the codes and try to figure out why we are paid $30 for a $300 visit; they may as well have been written in Latin.

And when we try calling, all too often we end up in a voice mail maze.
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Mr. Claxton noted, for example, that the anesthesiologist assigned to your operation may be out of network and then “that’s extra money.” You can ask about getting one in your network, but it is not always clear whom to ask or if that request will be honored, he said.

Also, be sure to ask when making any appointment if the doctor is currently in the network. Just because it says so in your plan’s book or online does not mean the doctor is still in the plan. Avoid a nasty surprise when the bill comes.
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Or, as happened to Karen Pollitz, a research professor at the Health Policy Institute at Georgetown University, an insurer can process a 12-year-old’s broken elbow as a workers’ compensation claim rather than as a sports accident — and then refuse to pay for it — simply because the doctor checked accident on the insurance form. ...