When most people think of dogs, they think of life-long companions who love unconditionally. However, dog bites are an unfortunate reality, affecting thousands of people each year. While some nips may just leave a small mark, others can cause serious injury and trauma. For victims, the physical and emotional recovery is just the beginning of a long journey that often involves navigating complex health insurance policies.
Seek Treatment First
After seeking initial emergency medical treatment, many dog bite victims require follow-up care such as wound cleaning, antibiotics, stitches removal, and scar treatment. However, many are surprised to discover that their health insurance may not adequately cover these expenses.
Most health insurance plans place the responsibility on the patient to understand exclusions and reimbursement rates for out-of-network providers. Many patients unintentionally go out-of-network in the panic of an emergency.
Avoidable?
Other health insurance concerns after a dog bite is that some health insurance policies may classify dog bite wounds as avoidable “self-inflicted injuries” on the same level as drunk driving. While this may be within their legal rights, this classification severely limits what follow-up care is covered. Confusing legal terminology and complicated policies mean even the most diligent patients have trouble figuring out what is covered.
This forces many dog bite victims to make an unfair choice – either live with severe scars and loss of function or pay out-of-pocket for restorative procedures. It can be infuriating and disheartening to discover these clauses after an attack, especially when it was out of your control. However, being an informed advocate from the beginning can help you navigate finding affordable care.
Tips
- Ask detailed billing questions upfront before receiving any treatment. Be sure to inquire if the medical facility and all physicians are in-network, what treatment codes will be used, what typical reimbursement rates for these codes are, and if there are required pre-approvals for any medications or follow-up appointments.
- Get pre-approvals for medications, specialists, lab work, etc, in writing. Even if a provider says an antibiotic or basic wound dressing will be covered, get the pre-approval reference number and representative name in writing. This will protect against surprise claim rejections later.
- Thoroughly review your health insurance policy and take notes on exclusions. This includes checking if there are any limits on urgent care visits, wound treatments, physical therapy, reconstructive procedures, outpatient surgeries, etc. Copy down word-for-word sections about animal bites and self-inflicted injuries so you can reference back when needed.
- Find medical bill advocacy services to negotiate costs post-treatment. If faced with astronomical bills, even with insurance, medical bill advocates have experience negotiating itemized charges and appealing insurance rejections. They usually charge 20-30% of the savings earned, making their assistance affordable if facing large bills.
- Appeal insurance claim rejections aggressively and persistently. Gather medical records, photos of wounds, treatment cost estimates, and patient advocate letters to appeal. Patients often win appeals if evidence proves procedures are necessary, non-cosmetic, or due to extenuating circumstances like an attack. Don’t take the first “no” on a claim rejection as the final word.
- Seek second opinions if initial treatment providers deem follow-ups unnecessary. Advocate for yourself if certain specialists refuse to see you without insurance pre-approval. Get another voice to confirm whether additional physical therapy, counseling, or reconstructive surgery is truly unviable or just not conveniently reimbursed.
While health insurance issues can compound stress after a dog attack, being proactive can help facilitate the best recovery possible. Taking the initiative to understandpolicies in depth, communicate with medical billing departments, and learn your rights as a patient will pay dividends. Although man’s best friend turned foe created hardship, persevering through administrative obstacles can gradually ease the financial aftermath.
