Richard Grace of Squirrel Hill has a Ph.D in physics, but when it comes to medical insurance he’s stumped.
Grace said, "It's very complicated almost impossible -- Nuclear physics is easy. Health insurance is hard."
Hard because finding out just what your plan covers is sometimes a frustrating and difficult process.
Grace found that out the hard way with a policy he thought covered 80 percent of his doctor’s visits.
Grace explained, "With one policy we had couple years ago it supposedly covered 80 percent of doctor’s visits. When you'd go to the doctor the bill would come broken down into three things: what the visit was, what the nurse did, and what labs went out. It was a $200 to $300 bill for whole thing and the insurance company would say we'll cover $50. You’d call up and say I thought you'd cover 80 percent and they’d say, yeah, but only up to what we think is fair."
Rhonda Orin is a Washington, D.C. attorney who represents consumers in disputes with insurance companies. She also wrote the book “Making Them Pay."
To make sure consumers don't end up with huge unexpected medical bills she recommends that consumers tell their doctors to use lab companies within their health care plan.
Orin said, "If you have a procedure and your doctor who you picked in plan sends, calls in, and does anything with a person or entity out of plan -- you're going to get billed out of plan."
And if your plan doesn't pay for a test that you feel you need, many experts say talk up your symptoms.
"If you have a reason to need that test, symptoms that justify the test that would be how you get that covered," said Orin.
Orin recommended skipping the phone calls and get everything in writing instead.
"If somebody on the phone who you don't know and isn't allowed to give you their name says 'sure you are covered' and then you get a denial, guess what? You have no way of proving that person said it was covered."
If you need to go to the emergency room and it's not life-threatening, get the OK from your primary care doctor first.
And don't forget your doctor is your ally.
Ask them to write letters or make phone calls on your behalf.