1) Get a referral: If you go to your primary care physician (PCP) for anything and you anticipate the need to see a specialist, ask for a referral AND get a copy of it. So if you are visiting your PCP to get a blood pressure check and you were thinking about seeing a dermatologist for a skin check sometime, physical therapy for nagging back pain, or plastic surgeon for skin tag removal, etc - ASK FOR A REFERRAL. It costs the doctor nothing except a piece of paper. It's great if you have a specific physician in mind, but if not, just get it on a prescription pad and take it with you.
2) Touch base with your insurance company: patiently wait on the phone to talk to a human being and ask if they cover X service and what the copay will be. Ask if there are limits to how much they cover and if you will be charged separately for hospital, lab, and office charges. Mention that you have a referral, even if you don't officially need one. Be nice; we'll discuss that in a minute.
3) Confirm your appointment and referral: When you set up your appointment with a specialist, make sure they have your referral on file. If they don't, give them your PCP's office information and bring your copy of the referral to the appointment. Everyone's office is interested in getting paid.
4) Review your bill and your insurance statements: If you get approved for a specialist or procedure, you should receive notice that you can see specialist Z for X number of visits. When you get your bill from the physician/hospital/lab (or all 3 separate bills), make sure insurance covered your visit. If you need to, ask for an itemized bill. Then call your insurance company and discuss what they did and did not cover. BE NICE. They get yelled at all day by irate people. If you are nice, they will be willing to refile claims for you, resubmit them, contact the doctor's office, or take it up with their supervisor.
5) Record name, date, and activity: Get the name and number of every person you talk to. Write it directly on the bill, '11/20/12 Talked to Sherry in customer services, will forward info to her supervisor and hear back in 30 days. 777-664-9041' Insurance companies and doctors office employees know each other and can confirm that type of information. Insurance companies generally will have an electronic record of this type of correspondence and will look toward that date you tell them in followup. It will also keep them from turning your over to collections.
6) Keep your records together: Come up with some type of filing system that keeps your medical bills in once place. I personally have a file on top of my desk that I keep the current projects in. I put sticky notes that say 'pending' on the ones that are in process. I move them to our general file system the main portions once they are resolved and shred the ones that were minor correspondence or extra copies.
Now for my true story. I was able to save somewhere in the range of $700 for medical bills during my pregnancy by calling and talking to hospitals, insurance offices, and doctors offices. I was in a car accident and had to be seen in the ER. Since I was pregnant, once they all agreed I didn't have a broken neck, they sent me up to OB floor. I was later asked to pay for the copay for the ER and then 'out of network' OB office costs because that was how the hospital charged for OB services. I was able to successfully get my out of network fees waived because it was an emergency visit and I didn't get to 'select' which OB was on call.
Furthermore, I had some bleeding at the start of my pregnancy and was referred to the high risk specialists. I was also going to VBAC, so when everything was okay, the high risk specialists kept me on as a patient even though I was not high risk at that point. I was just receiving normal care from their office. My insurance company would usually pay $6,000 for my entire pregnancy care and I'd be responsible for $300 as a bulk payment. However, since I kept seeing the specialists, I was getting extra bills for $50 after every visit. It took a bunch of phone calls, but I got the office to re-code for almost all of the visits and I only paid an extra $25.
Keep in mind, there was alot of waiting on the phone to get all of this done over a period of weeks, but it was WAY cheaper than actually paying all of those bills.
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