Tips: Dealing with your Insurance Company
When calling your insurance company, always take notes on conversations, especially the date, time, person’s name and direct telephone number, and record/call# assigned to the phone call.
Attach to disputed bill and EOB (Insurance Explanation of Benefits). Ask to speak to a supervisor if progress needs to be made. Consider assigning a case manager or ombudsman to help deal with pre-approvals or problematic denials—it gives you one consistent contact person.
Other options include having the Human Resources Director contact the Insurance Broker through which the medical insurance was purchased to help advocate your case or give tips on your appeal.
Links: Insurance Claims Denials & Appeals
Dealing with denied medical insurance claims? Complex Child E-Magazine has a great article, “Writing Winning Insurance Appeal Letters,” which can be downloaded here.
“How To Appeal A Health Claim Denial.” This is a helpful article from Healthcare.gov on an issue too many JM families experience. www.consumeraffairs.com/news04/2010/06/health_claim_denials.html
The PAF’s mission is to provide effective mediation and arbitration services to assist patients with chronic or life-threatening illnesses with Medical Debt Crises, Insurance Access Issues, and Job Retention Issues. This is a fantastic resource! www.patientadvocate.org
For Access/Approval Related to IVIG
IGLiving Magazine is an online and print magazine for the IVIG community www.igliving.com.
FFF Enterprises https://www.fffenterprises.com/site/company-contacts.html
External Insurance Appeals
Medical Insurance Issues? Appealing Claims? Know the contact information for the Insurance Commissioner’s Office for your state – the regulatory office for insurance – and the laws for your state.
Kaiser Family Foundation has a dedicated webpage “A Consumer’s Guide to Handling Disputes with Your Employer or Private Insurance – State-by-State External Review Programs”. This is for information about the Appeal Process reaching the external, state level. https://www.kff.org/wp-content/uploads/2005/07/consumerguide_jan2003.pdf
Other Helpful Insurance Links
Connecting Kids to Insurance Coverage www.insurekidsnow.gov/
Changes in Healthcare Law
Key provisions in health care reform went into effect recently. Do you know how the new laws will impact you & your family? Healthcare Law Update – July/August 2022
If you have a new insurance policy or purchased one on or after 09/23/2010, there are requirements to receive preventive services with no out of pocket costs. Please click here for more information on preventive care. www.healthcare.gov/law/about/provisions/services/lists.html
Know how Changes in Healthcare law and provisions affect you www.healthcare.gov/law/introduction/index.html
To enhance the understanding of insurance and healthcare reform changes following the passage of the Patient Protection and Affordable Healthcare Act.
Assistance With Medical Bills
The Patient Advocacy Foundation Co-Pay Relief (CPR) provides direct financial assistance to qualified patients, assisting them with prescription drug co-payments their insurance requires relative to their diagnosis. CPR call counselors work directly with the patient as well as with the provider of care to obtain necessary medical, insurance and income information to advance the application in an expeditious manner.
Genome.gov has a webpage listing helpful web links for “Assistance with Paying for Medical Care & Procedures”, “Financial Aid for Medical Treatments”, “Assistance for Paying for Medications”, “Assistance for Insurance Premiums.“
The Casey Cares Foundation website includes links to helpful resources and tools regarding financial aid.
NeedyMeds is a non-profit organization founded as a resource of information about patient assistance programs (PAPs) and developed into a database of PAPs, disease-based assistance, gov’t programs & other types of assistance programs.
RxAssist offers a comprehensive database of patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need.