Basic Tips on Working With Health Insurance

In my book,The Malformation of Health Care book (now available on Amazon.com, I detail several tips on how to navigate through our very complex and often times confusing health care system. Today I want to take you inside the book and give you some basics of where to begin. Although some of these topics may seem obvious, they are often things that are overlooked when we are thrown into stressful situations.

 

Checklist for Health-Care Rights and Service

 

  • Know your benefits: Get a printout from your insurer and know your deductible and out-of- pocket maximum. This way, you can track what you are responsible for. Be an educated consumer.
  • Ask for a case manager. This is a contact person within your insurance company who will know your case and be of real benefit to you if it is a complicated one. If your insurance company says you can’t have a case manager, keep asking. Once they see all the claims coming in, most likely the company will change its mind.
  • Keep all of your insurance claims and bills/booklets, which you can usually do online. Keeping hard copies is probably a good idea, just in case your computer or backup drive dies.
  • Appoint an organized family member/friend to help you with all of this because it can be overwhelming especially if you’re sick.
  • Reach out to a hospital social worker or to local nonprofit organizations (such as the Cancer Legal Resource Center, the Leukemia & Lymphoma Society, etc.) for ongoing help or support. They will know of good resources to help you if you’re in trouble and can save you a lot of legwork.
  • Write down the name of anyone you speak with at your insurance company every time you contact your provider or your provider contacts you. Make sure you record the full name, date, and a detailed synopsis of the conversation.
  • Follow up!
  • If you are denied coverage, do not be afraid to appeal. Jump through all the hoops the insurance company asks of you, and document everything. If, at the end of the appeals process, you need an attorney, you will have something to give him or her.
  • Learn all you can about your condition. A lot of times, insurance company workers know little about your illness and you must become your own best advocate.
  • Check with your insurance company about its fertility policies. I include this advice because many young adults are diagnosed with serious illnesses that may require heavy medications and treatments. At the point of diagnosis, someone who is in their late teens may not be thinking about future plans for a family.
  • Have a relationship of open communication with your doctors, who can help to advocate for you. Know that there is creative coding for blood tests and other procedures you may require to facilitate your health. A test that might not be covered if coded in one particular way may pass muster with your insurance company if coded in another way.
  • Know your out-of-network benefits. Sometimes you may be referred to specialists who may not be in your insurance company’s network␣ What is the percentage and how does your out-of- network benefit work with your deductible? Do any of the company’s in -network doctors offer the same care as the out-of-network specialist to whom you have been referred? If not, most policies have provisions to cover out-of-network providers when no in-network doctor has the same capability.
  • Try to connect all of your doctors, so that each knows about your health in relation to the other physicians providing your care. If you can start a group dialogue among your doctors, your care will be better.The Malformation of Health Care (Chapter 25) Copyright Erin Havel 2012.

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