With all this outdoor entertaining, it’s important to ensure you have the proper homeowners insurance to cover your property in case of damage, and to help protect against any injury liability claims.

“The outdoor space is something that people don’t think about much. If they think about home insurance, they think mainly about their house structure,” says Amy Danise, editorial director of Insure.com.

You may want to review your homeowners insurance policy this summer if:

1. You’ve made recent outdoor improvements and they might not be included. If you’ve added a hot tub, pool, outdoor kitchen, gazebo, or storage shed, check to see if it’s included under your current policy.

Generally, other structures are covered as a percent of your dwelling coverage, Danise says. For example, if your house is insured for $200,000, the other structures on your property are typically insured for 10 percent of that amount.

2. Your outdoor property is in bad condition; you could be on the hook financially if someone is hurt on your property. Check the condition of your outdoor property to help protect yourself from injury claims against your homeowners insurance policy. Make sure your deck and stairs are in good shape. Look for any wood decay, which can weaken the structural integrity of your deck. Fix any areas that need work, and perform ongoing maintenance.

Be aware that some outdoor damage to your property may not be covered under your homeowners policy, especially if the damage could have been avoided with routine maintenance. Damage from termites, insects, birds, rodents, rust, rot, or mold may not be covered.

3. You may not have enough coverage to protect you in the event someone is injured during a summer get-together. Figure out how much liability protection you have, as this can protect you against property damage or bodily injury claims if, for example, someone is injured at your barbecue or hurt in a pool accident. The standard coverage amount is from $100,000 to $300,000. Talk to your insurance professional to determine if this is enough coverage for your situation.

4. You think it may be time to purchase additional coverage. Consider purchasing personal liability umbrella coverage. Because astronomical lawsuits are not uncommon, personal liability umbrella insurance provides additional coverage—on top of your existing auto and homeowners policies—in increments of $1 million.

“It’s a pretty cheap way to buy extra liability,” Danise says. “And it generally goes on top of your home and auto insurance.”

Umbrella policies go into effect after the main liability limits on your homeowners or auto policy are exhausted. So you will need to have a high liability, like $300,000, in your main policy, and then you can buy an umbrella policy to extend the amount, she says.

5. You aren’t taking advantage of available savings. Review your homeowners policy periodically to make sure you are familiar with its coverage and to ensure you are taking advantage of any applicable discounts. Don’t get caught by surprise. “Check on your deductibles to make sure you’re aware of how much you would have to pay out if you have property damage, like a fire,” Danise advises.

This summer, enjoy your outdoor entertaining space—just make sure it’s adequately covered under your homeowners insurance to prevent a dreamy summer day from turning into a nightmare.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

As stressful as it sometimes can be, it’s possible to keep wedding expenditures in check by thinking of ways to stretch your budget. Luckily, there are many creative ways to make your money go further while still helping the newlyweds start their life together, says Jamie Miles, an editor of popular wedding website, TheKnot.com.

“Couples are aware of the economy and how it’s affecting different people,” Miles says. “They’re going to be understanding if you have to stay within a budget and get something a little less expensive off their registry. Yes, there are bridezillas out there, but at the end of the day, they’re going to understand.”

First, start by shopping early, before the couple’s gift registry is picked over, she says.

“The key to saving is to buy early. Generally about 52 percent of the items on a couple’s registry are going to be under $50,” she says. “If you go within the first weeks, you are still going to be able to buy items that are under $50.”

While The Knot’s Bridal Registry Study shows that friends typically spend $79 on a wedding gift and family members average $146, it’s fine to give an amount that’s comfortable for you, Miles says. “If you’re in the friend realm, it’s going to be a little more acceptable to get something less expensive off their registry.”

“Say that you settle on something in the $20 to $40 range, that’s OK. You can also personalize it a little bit more,” she says. “Say you get them a wine rack off their registry, you can add a couple bottles of their favorite wine. That makes the gift a little more personal, and it’s still going to be affordable.”

Another way to stretch your dollar is to team up with friends to contribute smaller amounts to a group gift. Some 70 percent of couples receive at least one group gift, according to The Knot’s Bridal Registry Study. “It might end up being a little more substantial of a present, but it’s not going to affect your wallet as much as you buying that substantial present alone,” Miles says.

Even if your budget is limited, wedding experts recommend getting a gift from the couple’s registry instead of trying to find a similar item at a lower-priced store.

“I would definitely recommend getting something from the registry. That’s what they need. The registry has been created for a reason. It’s like telling someone what you want for your birthday and them totally ignoring you,” Miles says.

Beth Bernstein, owner and event director at SQN Events, a premier wedding planning company in Chicago, agrees.

“If they’re registered for salad bowls, they would like those salad bowls. They don’t want other salad bowls from a different place. I would not go to a lower-priced store. I would just get fewer items off their registry that you can afford,” Bernstein says.

The idea is to make a gift special, even if your budget is smaller, she says.

“If you don’t have a big budget to give a wedding gift, a good idea is to donate to a charity that’s meaningful to a couple in their honor,” Bernstein says. “A donation is always appreciated.”

Most charities will send a card to the couple letting them know that a donation has been made in their honor, usually without disclosing the specific amount. This can help you feel comfortable staying within a limited budget.

Another alternative is to give a meaningful personal gift, such as a framed photo of the couple, a framed copy of their wedding invitation, a gift certificate to their favorite restaurant, or a contribution to their honeymoon registry. You can also give a gift card to the store where the couple is registered so they can buy items after their wedding. “They might still need two forks, but you might feel weird just getting them two sets of silverware,” Bernstein explains. “They can use [a gift card] for what they want after the wedding to fill in the holes.”

Of course, when budgeting for wedding season, there’s more than the wedding gift itself. The wedding gift usually amounts to 60 percent of the total gift expenditure, with 20 percent for the engagement present and 20 percent for the bridal shower, Miles says.

Plus, for out-of-town weddings, there’s also the cost of airfare and hotel. Make a list of all possible expenses, including all gifts, dress, shoes, hair, makeup, hotel, and airfare. Then figure out a total expenditure level that is right for you.

Whatever your gift to the couple is, Miles says, “It’s going to help them as newlyweds start a life together. They’re going to be thankful, regardless.”

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

While most federal regulations apply to business-to-consumer and not business-to-business telemarketing, small businesses can still cut down on unwanted solicitations. These resources may not stop the problem completely but could at least cut down on the number of robocalls—pre-recorded messages that come from a computerized auto-dialer—and spam emails.

Telemarketing calls

Telemarketers are prohibited from calling personal phone numbers listed on the National Do Not Call Registry (with the exception of certain nonprofit and political organizations). If you use your home or cell phone for business, this could be to your benefit.

You can list your home phone or cell phone on the Do Not Call list as long as that phone number is primarily used for personal calls and is not owned by a business, explains Roberto Anguizola, assistant director of the Federal Trade Commission’s Division of Marketing Practices.

“If a cell phone or home phone is primarily a personal number but occasionally used for business, a consumer is entitled to list that number on the Do Not Call list,” Anguizola says. But if you use your home phone for work and distribute that number to a trade association, then you might expect your number to get out to other trade organizations, and you will likely see an increase in unsolicited phone calls.

According to the Federal Communications Commission’s (FCC) website, “While you may be able to register a business number, your registration will not make telephone solicitations to that number unlawful.” So if your land line or cell phone is registered to your business, you may still get calls.

Keep in mind that under the Federal Trade Commission’s (FTC) Telemarketing Sales Rule, business-to-business calls for sales of nondurable office or cleaning supplies are restricted. Examples of nondurable office or cleaning supplies include paper, pencils, solvents, copying machine toner, and ink—anything that can become depleted and must be replaced.

The rule is in place, Anguizola explains, to prevent “toner phoner” office supply scams in which businesses are bilked to pay for goods and services they never ordered. If you feel this rule is being violated, you may want to contact the FTC directly.

Unwanted email

The federal CAN-SPAM Act requires that a commercial emailer give each email recipient an opt-out method, such as a return email address or a link allowing you to request that it stop sending future email messages. If you request to opt out, that company must stop emailing you, whether for business or personal email accounts.

The Direct Marketing Association (DMA) also has an Email Preference Service (eMPS) to help reduce unsolicited commercial emails you receive from DMA members. Registration is free and good for six years, but, according to the DMA’s website, “does not apply to advertising emailed to your business address.” The eMPS therefore will apply mostly to small business owners who use their personal accounts for correspondence.

And although registration will get you off of some email lists, it won’t completely clean up your email inbox because not all advertisers participate in the service. If you’re a small business owner who uses a business email account to correspond with clients, you may be better off just setting up a good spam filter.

Junk mail and faxes

Unsolicited advertisements sent to fax machines are restricted under the Junk Fax Prevention Act of the Telephone Consumer Protection Act (TCPA). Specifically, the policy restricts the use of “any telephone facsimile machine, computer, or other device to send an unsolicited advertisement to a telephone facsimile machine” for residential as well as business fax machines.

The Act does permit the sending of advertising via fax to both individuals and businesses “with which the sender has an established business relationship.” However, the rules require senders to provide notice and contact information on the fax that gives recipients the ability to opt out of future faxes from the sender.

In addition to the eMPS, the DMA maintains a Mail Preference Service (MPS) for consumers to opt out of receiving unsolicited commercial mail from national companies that participate in the service.

But the service isn’t designed for businesses, explains Jerry Cerasale, senior vice president for government affairs of the DMA. “The problem with requests to stop business-to-business marketing is: Who is authorized to request it? Does it apply to the entire company? If it applies to an individual in the company, does it apply to that individual’s replacement when he or she leaves the company?” he says.

Instead, Cerasale explains, if a small business is receiving unwanted mail, the business should contact the marketer and request that the marketer stop sending any more advertising.

While you may never be able to completely rid yourself of telemarketers and spam, these services may be able to help you cut the problem down.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

As shrinking state and federal budgets take their toll on schools, parents are stepping up and funding more of the extra programs that enhance their schools—programs like partnerships with local theater companies, field trips, and new computers for classrooms.

For some families, it’s hard to balance multiple requests for time and money. But parents don’t need to break the bank to support their schools, experts say.

“No one is expecting a parent to go into debt for a fundraiser,” says Tim Sullivan, president and founder of PTO Today, a magazine and website for school PTOs and PTAs. “Fundraisers work best when there’s a broad base of modest support. As a parent, you’re not solely responsible for funding the field trips. No one’s expecting a parent to hit the credit card and be paying it off for six months because a kid needs a field trip.”

Even small contributions help support a good cause, says Laura Mueller, fundraising chair for her school’s fundraising group, Friends of Bell School.

“With our school being a public school, parents have to fund all the extra programs to make their school great,” Mueller says. “They need math books, projectors, technology—anything that helps teachers do their jobs better. I feel if I make our school great, that’s my priority. That’s where all of my money goes.”

For school fundraisers that sell products, like wrapping paper or cookies, typically 40 percent to 60 percent of the money raised goes directly to the school, Sullivan says. Of the remainder, some money goes to the actual product you receive (the wrapping paper or cookies) and some goes to a fundraising company.

Parents who don’t want another roll of wrapping paper can choose to give a cash contribution to the school or PTO instead.

“There’s not a school or PTO that wouldn’t take a cash donation. Support is support; it’s great,” Sullivan says. While the wrapping paper fundraiser might be counting on a certain amount of sales volume, “if you want to support [the school] any way you can, go for it.”

Mueller’s school, Alexander Graham Bell School in Chicago, runs a “wish list” fundraiser where parents can direct donations to a targeted fund, like a fourth grade poetry residency, a sixth grade technology fund, science fair materials, or art supplies.

“People all want to know where their money goes—every single dollar,” Mueller says. “We work really hard, and there’s a huge administrative team to make sure that every dollar goes where the parents want it. It’s not going to overhead or administrative costs, but it’s actually going to a book. That’s rare for a fundraiser.”

Not many schools offer such a targeted approach, but parents can talk to their school or their PTO to see if a targeted “wish list” fundraiser would work in their community.

Parents can also ask the PTO how many fundraisers it runs each year. Then parents can set a yearly donation budget and choose whether to participate a little bit in each event or make a bigger contribution to one event, if they are able.

Many parents need to balance requests from extracurricular activities too, Sullivan says.

“More typical for a family with budgeting concerns is: ‘I’ve got four kids. I’ve got three soccer teams, three basketball teams, two different schools. I can’t be the lead fundraiser for eight different causes,’” Sullivan says, speaking from his personal experience. “We wouldn’t make it with so many kids and so many activities. There aren’t enough hours in a day or dollars in our pocket to do it all.”

Sometimes it takes a village to complete the whole picture.

“Both time and money are different for every family. There are families who have no extra time and no extra money. And there are families that have both, if they’re very lucky,” Sullivan says. “I talk about it with PTOs a lot. There are some PTOs that put things out there, like if you can’t help, then your kid doesn’t get the field trip. Whoa, hold on: The mom is working 50 hours a week and is alone with three kids. Her time and money is very different than yours.”

If it’s possible to contribute an amount that’s comfortable for you, it can help cover parents who aren’t able to contribute, he says.

“For me, working at a school, what am I volunteering for?” Sullivan asks. “It’s so all the kids can have great [resources]. Not only the kids whose parents can help…. We’re all in this together.”

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

In fact, the SBA guarantees loans to small and mid-sized companies. Banks and other lending institutions make the loans themselves.

SBA-backed loans can encourage banks to lend to small businesses, giving them access to capital to help start or grow their businesses. But it’s important to understand the intricacies of the loans, says Denise Ching, associate director of the Illinois Small Business Development Center at UIC, part of the network of regional Small Business Development Centers that are funded by the SBA and state and local governments to provide free services to small businesses.

“The SBA is not a direct lender. [It provides] incentives for lenders to make more loans,” Ching says. “It’s up to lenders to decide whether they want to use the SBA loan guarantee or not.”

An SBA-backed loan can be a good solution for a young or start-up business that is turned down for conventional underwriting because it has insufficient collateral, it has been in business for less than two years, or it is funding a business acquisition, among other situations.

But an SBA loan guarantee is not a magic bullet. “That guarantee is not meant to cover up a bad credit decision,” Ching says. “It’s meant to help where there’s maybe one hole, but not when you’re covering five holes, you’re in trouble, and you’re losing money—that’s not when you get an SBA loan.”

“A loan is not to save you from a poorly managed business,” she adds. “You have to be able to pay it back. You have to be able to demonstrate in your financial statements that you can afford those loan payments every month for the next three to five years.”

To improve your chance for a SBA-backed loan, get your financial house in order by reviewing your personal credit history and assembling a complete financial package to make the case for the stability of your company. View the SBA loan application checklist on the SBA site and be prepared with the following tips:

Understand the types of SBA loans. The most common, most flexible type of SBA-backed loan is the 7(a) Loan Program, which can be used for a variety of purposes, including buying machinery, equipment, or furniture; purchasing real estate; making leasehold improvements; generating working capital; or even refinancing debt. There are different types of loans within the 7(a) category, including special purpose loans and express programs like the SBAExpress, which promises a response to an application within 36 hours.

Another type of SBA-backed loan is the CDC/504 Loan Program. This provides approved small businesses with long-term, fixed-rate financing used to acquire fixed assets such as major machinery or equipment for expansion or modernization.

And finally, the Microloan Program provides small (average $13,000) short-term loans to small businesses and some not-for-profit child-care centers through community-based organizations with experience in lending as well as management and technical assistance.

Gather financial statements. Assemble a complete application package including business and personal tax returns from the past three years, profit and loss statements from the past three years (for an existing business), projected financial statements, a recent balance sheet, and the company’s business plan, reference letters, business license or certificate, and loan application history. A complete package should give a lender a good feel for your company and for what you will use your loan.

Consider your collateral. The SBA requires that the applicant put up all available collateral for loan repayment. If business assets do not fully secure the loan, personal assets may be considered as collateral, including the equity in your home or any assets jointly owned with your spouse. The SBA requires personal guarantees from people who own 20 percent or more of the business, as well as from other individuals who hold key management positions.

Seek assistance. The SBA funds a broad network of regional Small Business Development Centers and SCORE mentors that help small businesses with free programs. These services provide valuable advice in preparing SBA loan applications.

Contact lenders. Find a bank, credit union, or other lender that works with the SBA. The SBA has a list of lenders by state, with a chart of the number of loans the lenders make along with the overall loan amount. Ching suggests dividing the loan amount by the number of loans to come up with an average loan size for each bank so you can match your needs with a lender that handles similar-sized loans.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

Pricing communicates quality, says Bryan Ziegler, director of the Small Business Development Center at Indian Hills Community College in Ottumwa, Iowa, which offers free advice to small businesses in the region.

Often, entrepreneurs tell Ziegler that they are starting a new business that will be of better quality and that will have lower prices than the competition. “To me that’s wrong or backwards,” he says. “If you have better quality, one of the ways to communicate quality to customers is through a higher price…. Low price communicates low value.”

People often will purchase services even if the price is higher because they want a high-quality product or better service, Ziegler says. The Iowa Small Business Development Center offers a useful tip sheet titled “How To Price Your Products and Services,” which includes tips for determining costs and assessing your competitive position.

It’s important to research the competition, says Mary Lysaught, a SCORE mentor with an extensive background in marketing. SCORE, a nonprofit association that helps small businesses grow through education and mentorship, offers free or low-cost programs and advice to small businesses.

“I want [entrepreneurs] to focus on the competition,” Lysaught says. “I want them to know their competitors just like they know themselves. Whether it’s privately held or whether it’s publicly held, we give them tools to search as deeply as they possibly can on all aspects of that competitor, not just pricing.”

After researching the competition, it’s important to think about your desired brand image and quality, says Lysaught. “We look at positioning strongly. When you look at positioning versus your competition in an open marketplace, the [brand] image has got to be there. That image sometimes drives the level of pricing that you’re shooting at.” In addition, Lysaught emphasizes the synergy of the “4 Ps”—product, place, pricing, and promotion.

To determine a price for your product or services, you’ll need to first capture your costs. “Be conservatively low on the volume you might sell and a little high on [estimating] overhead, so you have the ability to cover all costs,” Ziegler says.

For services, figure out an hourly rate and how many hours a specific job will take, and then convert that into flat per-project fees, Ziegler advises. “Many people start out thinking they should charge by the hour. I try to get people to think about charging by the job. You actually can create more revenue,” he says.

Some suggestions to help you get the price right:

Determine your expenses. If you are selling a retail product, your expenses include the material and manufacturing costs to produce the product, as well as labor costs.

Calculate your overhead. Overhead expenses include office equipment and furniture, rent and utilities, advertising, telephone expenses, supplies, vehicles, liability insurance, medical insurance, and taxes.

Set a profit margin. You’re entitled to earn a profit over your salary and expenses. While there is no standard profit percentage, a 10 percent to 20 percent profit is common.

Adjust prices as necessary. Your price does not need to be set in stone. Keep track of your expenses, sales, and overhead costs. Once you’ve gone through a trial period and your experience builds, you may be able to reduce your costs and prices. Or you may need to increase them over time because of inflation or industry trends.

• Set your price above the competition. Small businesses can sometimes justify charging a higher price because of better quality and better service. If your price is above the competition, make sure your marketing materials reflect that higher quality and higher satisfaction as well as personalized service.
• Set your price below the competition. If you have a low-end competitive pricing strategy, reduce your costs by closely controlling inventory, limiting product lines, and offering limited services. Be aware that you must constantly monitor and adjust costs, which can expose your business to pricing wars.

Find more information. For free small business advice, contact Small Business Administration District Offices, Small Business Development Centers, or SCORE mentors.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

Yesterday’s blog covered how to be a proactive and informed consumer, how to find the best health insurance plan, and how to deal with health insurance errors. Today we will cover how to take advantage of all the services offered by your health insurance plan and how to get the most out of your health insurance.

Take advantage of preventative services

If you joined your health plan on or after Sept. 23, 2010, the Affordable Care Act allows you to get many preventive care services for free from a network provider, without a co-payment or co-insurance. Depending on your age, you might have access to free blood pressure, diabetes, and cholesterol tests; mammograms, colonoscopies, and other cancer screenings; flu and pneumonia shots; and well-child visits from newborn to age 21.

If you were enrolled in your plan before Sept. 23, 2010, check with your insurance company; your plan may still offer some of the same preventive care benefits.

Go generic or order medications by mail

You probably are already aware that generic drugs cost less than brand-name drugs, but you might be surprised at just how much money you can save by using them. When your doctor writes you a prescription, ask if it’s OK to get the generic drug.

Also, check to see if your insurance company offers a mail-order program. You can usually order a 90-day supply of the medication at a reduced cost. Brand-name drugs can fall into different tiers, with Tier 4 specialty medications requiring higher co-pays or co-insurance. Check with your insurance company to see in what tier your medication falls.

Stay in network

Use a doctor who is in your health plan’s network; going out of network can result in much higher costs and co-pays. Your insurance company has negotiated better rates with in-network doctors and health centers. But don’t just check that your physician is in network—make sure hospitals, medical supply companies, home health providers, and imaging centers are part of your network too.

Track your out-of-pocket costs

Especially when buying individual insurance, consumers may be tempted to enroll in a high-deductible plan. Under these plans, you pay a low monthly premium, but then you pay for your medical expenses out of pocket until you reach a high deductible limit that can be thousands of dollars. This type of plan can work if your medical expenses are low, but unexpected expenses can rack up the costs. Look beyond the premium and tally up your out-of-pocket costs to see if you are in the right plan, advises Mark Cowell, manager of consumer marketing for GoHealth, an online and offline resource that helps individuals to find health insurance plans.

Plan around your deductible

If your insurance deductible is $500, that means you must pay the first $500 in medical expenses out of pocket before your plan pays for any covered services. If you think you will be incurring high fees for upcoming medical procedures, try to schedule your procedures within the same deductible year so you only have to reach your deductible once. Also, keep in mind that some plans have a separate deductible for in-network providers and out-of-network providers.

Save your receipts

Save your healthcare receipts for tax time, as you might be able to deduct some expenses from your taxes. If you are self-employed, you may be able to deduct your health insurance premiums. If your healthcare expenses exceed 7.5 percent (or 10 percent after December 31, 2012) of your adjusted gross income, you may be able to deduct a long list of qualified health expenses ranging from nursing home services to acupuncture.

Find the freebies

Many employer-sponsored health plans are laced with extra bonuses to keep you healthy, thus lowering long-term healthcare costs. Some plans offer free programs, such as access to a health coach online or over the phone, a nurse’s line that you can call for non-urgent medical advice, smoking-cessation programs, weight-loss programs, and even discounts on gym memberships.

Check costs

Be knowledgeable about your healthcare bills. Check to make sure the bills are correct and that you haven’t been wrongly billed for services you didn’t receive. Also, compare prices of medical services; using a more expensive provider can hit your wallet harder than you’d think. Online sites like Simplee.com offer a useful dashboard that helps you make sense of your medical bills, track medical expenses, and manage healthcare costs.

Enroll in a health savings account

Many companies offer health savings accounts (HSAs). HSA money is deducted from your paycheck pre-tax and set aside for your healthcare expenses. The money in this fund is tax-free. You can use it for doctor’s visits, lab work, and even hearing aids and eyeglasses. The unused balance in your HSA can roll over, so you won’t lose your money if you don’t spend it all within the year.

Give your health plan a checkup

Examine your plan yearly to make sure it is still right for you. Add up your expenses throughout the year to make sure your plan has the correct deductible level for your family. Your plan may also need to be adjusted if you’ve had any significant life changes, like pregnancy, the birth of a child, marriage, or divorce. Tools like GoHealth, HealthCompare, or eHealthInsurance can help you compare different plans, benefits, and costs.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

Americans spend thousands of dollars on healthcare costs each year, but just having health insurance isn’t enough. To maximize your health insurance plan, you need to utilize its benefits effectively. With dollars flying out of your pocket for your insurance premium, co-pays, out-of-pocket costs, and prescription drugs, it’s important that you get the most for your money.

Be an active, proactive healthcare consumer, advises Mark Cowell, manager of consumer marketing for GoHealth, an online and offline resource that helps individuals to find health insurance plans.

“Once you purchase the plan, you have to use the coverage wisely, and that’s something that’s really important. When you’re looking at your healthcare bills, you want to be sure you are not spending money where you don’t need to be,” he says.

“A big part of being a smart healthcare consumer is being a very curious healthcare consumer,” he says. “Ask your doctor a lot of questions and make sure that the procedures that they’re providing for you are actually necessary.”

It’s important to pay close attention to your healthcare bills, says Cheryl Fish-Parcham, deputy director of health policy for Families USA, a national nonprofit, nonpartisan organization that works to promote high-quality, affordable healthcare.

“Healthcare bills often include errors,” she warns. “Perhaps your health plan did not understand why a service was necessary, and so it did not reimburse for that care. Or perhaps the provider did not properly code or record an expense or payment. You should try to resolve these problems as soon as possible.”

The errors can be expensive, so make sure to stay on top of your bills.

“If you think your healthcare provider made a mistake, talk to the provider’s billing office and document the outcome in writing,” Fish-Parcham says. “If the erroneous bill has gone to collections, be sure to request a copy of your credit report and ask that any errors on it also be corrected.”

Everyone from the receptionist at your doctor’s office to the pharmacist to the insurance adjustor can make mistakes. Be an informed consumer and stay on top of your healthcare coverage and expenses. Come back tomorrow for more ways to get the most out of your health insurance plan.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

Steps to take for your first health insurance appeal

• Review the denial letter sent by your insurance company, paying close attention to the specific reason given for the denial. Read your health insurance policy to see if it addresses the specific reason for your denial. Review all the rules of your insurer’s appeals process and note any deadlines; you may have a limited time in which to appeal.
• Check to make sure the claim is coded correctly. Sometimes benefits are denied because the doctor’s office has entered the wrong billing code.
• Keep a notebook or a file folder to document all correspondence. Create a log of all your insurance-related calls, including date and time of call, name and title of the person with whom you spoke, and all the details of the conversation.
• Keep copies of all letters received, including denial letters, explanation of benefits letters, bills from your provider, medical records, and letters from your physician. Get a copy of your plan’s full benefits language, sometimes called the “evidence of coverage,” as well as the detailed guidelines that explain what the company considers medically necessary.
• Ask your doctor to write a letter discussing your specific case and why your treatment is medically necessary. Find articles about your medical condition or treatment published in peer-reviewed clinical journals and send them to your insurance company. Include any pertinent medical records, such as pathology reports or names of chemotherapy drugs you have already tried.
• Write your appeal letter. Be clear and firm, and focus on facts rather than opinions. State that you will continue to pursue the appeal until the claim is paid or care is approved. Keep a copy of all documents for yourself, and send your appeal packet to the insurance company via registered mail. Follow up with your insurance company to track the status of your appeal, taking notes on each call.

Steps to take for your second health insurance appeal

• If you are denied a second time, you can file a second appeal, which will typically be reviewed by a medical director at your insurance company who was not involved in the original claim decision.
• Read the second denial letter carefully. It may ask that you submit specific information that was not received with your first appeal letter, and it may ask you to send a new packet to a different person.
• Notify your doctor of the second denial, and gather any new information that is needed. Follow your insurance company’s instructions carefully, paying close attention to all deadlines. Keep copies of all information and letters, and send the new packet via registered mail.

Steps to take for your third health insurance appeal

• If your appeal is denied for a third time, you are eligible to ask for an external review from an independent, third-party reviewer. The external review board is typically made up of nurses, attorneys, and doctors who specialize in the specific procedure you are asking the insurance company to cover. The board cannot override your insurance policy guidelines, but it can determine whether a specific treatment is medically necessary.
• Make sure you understand and follow your health plan’s internal appeal process and the external review program’s procedures and requirements. Also verify that you’ve exhausted your health plan’s internal appeal procedure before asking for an external review.

More resources:

The Affordable Care Act provides for federal grants that help states start or strengthen consumer assistance programs to assist consumers with appeals and help them understand their health insurance rights.

Notices from your insurer should give you contact information for the consumer assistance program in your state, but you can also find a list at www.healthcare.gov or call your state insurance department.

If your insurance plan is through your employer and you believe you have been denied a health benefit inappropriately, you can contact a benefits adviser at the U.S. Department of Labor’s Employee Benefits Security Administration website or by calling 1-866-444-3272.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.

But you don’t need to accept the denial as the final answer, health advocates say. If your insurance claim is denied, you can file an appeal—or several appeals, if necessary—to try to get your insurance company to cover the procedure.

The first step, though, is to avoid a denial in the first place by understanding your health insurance plan, says Erin Moaratty, chief of mission delivery for the nonprofit Patient Advocate Foundation, a free service that helps consumers with health insurance appeals.

“Review and learn the limits and guidelines of your particular policy,” Moaratty says. “Follow the policy to the best of your ability. If you are required to gain a referral, do so to avoid a denial.”

While some denials are clear-cut—for example, if an HMO requires you to remain within its network and you go to a specialist that is out of network—others might be more subjective: An insurance company might deny preauthorization for a procedure that it thinks is a non-standard treatment. It might reject a promising cancer therapy that your doctor has recommended because the therapy is considered experimental. Or it might refuse to pay for a medical service that you’ve already received, deeming that service not medically necessary and putting you on the hook for payment.

Understand the health insurance appeal process

Previously, the health insurance appeal process and external review process differed in each state. Now, the Affordable Care Act, President Obama’s healthcare plan, gives patients rights to appeal and ensures the right to an external review, though only for health plans created or purchased after March 23, 2010.

If internal appeals within the insurance company are denied, consumers have the right to request an external review. It’s worth the hassle. Consumers who appeal outside of their insurance companies win their cases an average of 45 percent of the time, according to the Kaiser Family Foundation.

“When submitting your appeal, keep in mind that the best defense is a good offense,” Moaratty says. When putting together an appeal packet, craft it with as much supporting detail and as many documents as possible. Also, keep a close eye on any deadlines specified by your insurance company.

“A patient’s policy will outline the specific timeline and process for contesting a denied claim. If you do not appeal in a timely manner, you have no recourse,” she says. “There are three levels of appeals, so even if the first appeal does not go in favor of the patient, we encourage [him or her] to continue the process, paying very close attention to the details of why [it was] denied and the timeframe to appeal.”

Come back for next week’s blog with tips for filing a health insurance appeal.

A Chicago-based writer and editor, Eve Becker writes about personal finance, health and other topics. She is a former managing editor of Tribune Media Services.