It’s common for claim appeals to be denied multiple times before they’re properly reviewed and, in many cases, reversed. Understanding the appeal process and preparing strong support for your appeal can increase your chances of success. 

For planned, non-emergency procedures, confirming details ahead of time is key. Verify which providers will handle your care and any specifics of the procedure with your insurance company. This can help prevent unexpected claim denials. In emergency situations, it’s often impossible to verify every detail, but remember that all claims from ER visits should be covered as in-network. 

Most insurers have a structured process for appeals, which can typically be started through your member services portal. Be prepared for multiple rounds of appeal; it’s not unusual for initial submissions to be denied. It may take 2-3 appeals before your insurer does a full review. 

Make sure to support your appeal with clear documentation. Avoid vague statements like "just because." Instead, provide specific reasons, doctor’s notes, or other relevant information to strengthen your case.

My Health Aviator offers year-round guidance to help you navigate insurance claims and answer questions before your procedures. Our team can help make the appeal process smoother and less stressful, so don’t hesitate to reach out to us for support.

Begin by researching your treatment options. While your doctor may suggest a standard plan, learning about alternative approaches or additional options can help you make informed decisions. Once you’ve considered your treatment options, align them with your health insurance coverage to avoid unexpected costs.

Reviewing your insurance coverage in detail is critical before starting any treatments. Don’t proceed with treatment until you understand any potential out-of-pocket costs. If you’re unsure, contact your insurance provider or your healthcare facility’s billing department for an explanation of coverage and costs. 

Yes! If you have supplemental policies—such as critical illness, accident, or hospital indemnity insurance—check to see if they offer cash benefits upon diagnosis. These benefits can often be used to help with out-of-pocket costs or unexpected expenses related to your treatment. Reviewing and maximizing these policies can provide financial relief. 

By understanding your insurance benefits upfront and asking questions about treatment costs, you can significantly reduce the risk of unexpected charges. Always confirm coverage details before beginning treatment, and avoid committing to anything without a clear understanding of the costs.

Navigating a diagnosis can be challenging, and you don’t have to go through it alone. If you need help understanding your insurance options or maximizing your benefits, reach out to a professional or support service. Having someone to guide you can make all the difference in managing your health and finances effectively.

Still feel overwhelmed? That’s completely normal—and that’s why My Health Aviator is here to help. We understand what you're going through because we’ve been there ourselves. Reach out today, and we’ll start providing the support you need, right away. 

Insurers and healthcare providers negotiate costs for services, and sometimes they disagree on pricing. This creates “in-network” providers (who have agreed to the insurer's rates) and “out-of-network” providers (who have not). Unfortunately, this limits your control over who you can see, especially in urgent situations.

You have two main options for broader access to care: 

1. National Network Coverage: Look for an insurance plan that includes a national network, or, if available, consider employer-sponsored plans that offer nationwide coverage. These plans generally provide access to a wider range of providers across the country. 
2. Supplemental Insurance: Supplemental plans provide a cash payout if you become ill or injured, which can help you pay for services from out-of-network providers. This cash can be used as you see fit, even to negotiate lower costs directly with healthcare providers. 

Supplemental insurance gives you a cash payout that can be used for any medical expenses. This gives you flexibility to cover costs with out-of-network providers or pay for additional care that may not be fully covered by your primary insurance.

Plans with a national network offer more consistent access to healthcare providers across the U.S., giving you freedom to choose providers regardless of location. This is especially helpful for people who travel often or live in areas where in-network options may be limited.

In these situations, a national network plan or supplemental insurance plan will give you more flexibility. You’ll have access to care in different locations without facing high out-of-network charges, and supplemental insurance can add financial support wherever you are. 

Still have questions or feel overwhelmed? That’s normal, and My Health Aviator is here to help. We understand these complexities and have been through them ourselves. Reach out, and we’ll support you in finding the best plan and coverage to fit your needs 

If you have an HMO plan, yes, you’ll need a referral from your primary care physician. However, keep in mind your physician may not check if the gastroenterologist is in-network for your insurance. 

Tip: Use your insurance provider’s online directory or call the gastroenterologist’s billing department (not the front desk) to confirm they’re in-network before scheduling. 

For ACA-compliant plans, preventive visits are often covered at 100%, which means you might not pay anything out of pocket. If your visit is a follow-up, however, it may not be fully covered. 

Pro Tip: When you check in, let the front desk know if it’s a preventive visit. Sometimes they charge based on general policy guidelines, so make it clear to avoid unexpected payments.

Yes, it’s a good idea to confirm this. Anesthesiologists may operate separately from the facility where your colonoscopy is done, and they might be out-of-network, leading to extra billing. 

Solution: Ask who the anesthesiologist will be and call them directly to verify they’re in-network or billed under the facility. This step can save you time and unexpected costs.

My Health Aviator offers year-round guidance services to help you navigate the insurance process and answer any questions before your procedure. Reach out to us for help making the process smoother and stress-free!