Protect your wallet from unexpected medical bills

Health insurance horror stories like those in Michael Moore's laugh-till-it-hurts documentary "Sicko" do happen. No one wants to learn that their insurance company won't pay a major doctor's bill. What can be done to make sure it doesn't happen?

Here are three practical tips to help protect against unexpected bills and get the most for health insurance dollars:

•Check the fine print for special benefit limitations. Save money and hassle by reading through coverage details, especially the health plan's "exclusions and limitations." Insurance companies often limit coverage for specific benefits.

"For example," said eHealthInsurance executive Bruce Telkamp, "your health plan may limit the number of physical therapy visits you can make in a year. If you go over that limit, you'll pay the difference yourself."

Health plans may also include a "lifetime maximum," which represents the maximum amount the insurance company will pay for all medical claims in a lifetime. A quality health insurance plan with comprehensive coverage will typically have a lifetime maximum of $5 million.

•Make sure the doctor prescribes only covered drugs. Some health insurance companies maintain lists of all the prescription drugs that they are willing to cover with a doctor's prescription. Such a list is called a "formulary," and drugs that don't appear on the list are typically not covered. A doctor may or may not be aware of the health insurance company's formulary. Get a copy of the drug formulary from the insurer and consult it when a doctor orders a new prescription.

•Use the preauthorization

or appeal options. Health insurance companies will typically only cover services they consider medically necessary. When considering an expensive procedure or surgery, even one ordered by a doctor, make sure to apply for preauthorization. This usually involves providing the insurance company with medical records and a letter from the doctor.

This story is provided by North American Precis Syndicate Inc.