How to Effectively Cover Treatment with Gaps in Health Insurance Coverage

4 ways to deal with gaps in health insurance coverage.

At TMS Solutions we are about help those suffering from depression into treatment, and insurance is a big part of that. In that spirit, we??e passing on an article written by Andrew Rombach.

Have you ever gone to a doctor or hospital, gotten yourself patched up, and then stared down at an unexpected bill when you checked the mail a few weeks later? Maybe you weren?? expecting a bill, or maybe it?? higher than you thought it would be. Why doesn?? insurance cover some medical bills? People get charged for healthcare when they experience a gap in insurance coverage.

Gaps in health insurance coverage are more common than many people think, but why do they happen? Surely if you pay your monthly premium (or your employer pays it for you), you should be covered! Not necessarily. Coverage gaps happen for a number of reasons:

  • Your procedure or treatment wasn?? a qualified expense. For example, not all insurance policies cover things like acupuncture or tooth whitening; if you have those things done, your insurance will leave you to pay it all on your own.
  • Insurance has a cap or rules for total cost. If your bill is exceptionally large, insurance may not cover it all.
  • You went for treatment that did not align with your policy coverage options. Maybe you went to a dentist with insurance that doesn?? cover dental or you forgot to re-enroll in your health insurance and so lapsed in coverage.

Even if you thought you were covered but weren??, the bill still needs to be paid. So what are you supposed to do after a gap in coverage that looks like it?? going to cost you an arm and a leg? Thankfully, you have options.


1) Call Your Insurance Company About Expanding Coverage

If there are gaps in your standard coverage and health plan before you seek treatment, speak with your insurance company about your upcoming procedure and see if you can expand your coverage to include it. Some insurance companies are able to offer temporary help or even a permanent expansion to coverage, so it?? worth talking it over.

Most insurance companies have a hotline or online chat feature, so you can speak with a representative in real time rather than dealing with slower responses via email or snail mail. The online chat feature or email is especially helpful, as you have a written record of your new coverage.

The positive of expanding your coverage is that you can see more extensive assistance in the future. However, be prepared to see your premiums increase; more coverage typically equals more cost upfront. If you??e trying to expand your coverage on short notice, the insurance company might be limited in what it can do as well; try to allow as much time as possible before your procedure if you??e thinking about expanding coverage.


2) Try to Negotiate a Medical Bill Payment Plan

If your medical bill has already come in the mail, it?? too late to try to expand your coverage??t least for that particular procedure. However, you may be able to negotiate a payment plan to help break the amount owed into more reasonable chunks. While this option heavily depends on who is issuing the bill??o company is obligated to provide this option??t?? certainly worth trying.

If you??e working with a large organization, like a hospital, try calling the billing department and asking what they can do for you. They may require you to jump through some hoops to verify your income or qualifications for assistance; people who make a significant amount of money are typically not eligible for payment plans, but those who make an average or below average income may receive assistance. The billing department can often treat the owed amount like a no-interest loan, spreading payments across multiple months or even years.

If your bill came from a trusted doctor or small practice, you may have luck speaking to them directly about setting up a payment plan. While not all small offices regularly practice this, they may develop a plan just for you.

When providers help you set up a payment plan, you usually don?? have to pay interest and can pick a repayment plan that works for your budget, which is a huge plus. However, not all offices or organizations offer payment plans, and you may not learn this until you already have a bill to pay.


3) Try to Negotiate the Bill Down

Similar to establishing a payment plan, you may be able to negotiate the actual amount of your bill. If you can demonstrate financial need or a competitor?? (lower) price for service, your provider may cut the cost of your bill. Make sure to review your billing summary for your care when you receive it; some people report being charged twice for things like IVs, and pointing out these errors can get your bill sliced down.

While one major advantage of this strategy is that you may owe less and save money, success is hit or miss. Some providers don?? offer financial need bill reduction, and your bill may be accurate as sent, so you have nothing to debate.


4) Take Out a Personal Loan

One of the most well-known uses for a personal loan is to cover medical bills, and there?? a reason for that??ersonal loans offer quick disbursement, flexible amounts, and a variety of payment plans. This method is almost equivalent to putting yourself on your provider?? repayment plan, but personal loans come with interest. However, if you have good credit, you may be able to secure a low rate that makes paying back debt manageable.

Unfortunately, consumers with less than stellar credit or no credit history at all could be stuck paying high interest rates, making an already costly medical expense even more of a struggle. Furthermore, missing payments on this installment debt may, and probably would, have an adverse impact on your credit.



If you are updated on your insurance coverage, then you should be able to avoid any big surprised. Despite this, surprises still happen. While receiving an unexpected (or unexpectedly large) medical bill in the mail might put a damper on your day, remember that it?? not hopeless if your insurance falls through.

You have a plethora of options for dealing with your debt, and some options??ike a provider-sponsored repayment plan or bill reduction??ight actually be more convenient and save you money! Make sure to check over your bill and work with your doctor?? office to turn the situation in your favor however possible.

If you??e considering TMS therapy, and would like to talk about insurance and any gaps regarding coverage, let?? talk.

Schedule time with our Patient Advocate.