Tips: Dealing with your Insurance Company
When calling your insurance company, always take notes on phone conversations, esp. date, time, person’s name & direct phone number/ext. number, and record/call# assigned to phone call.
Attach to disputed bill and/or EOB (insurance Explanation of Benefits). Ask to talk to a supervisor, if progress is not being made. Consider being assigned a case manager or ombudsman to help deal with pre-approvals or problematic denials – it gives you one consistent contact person.
Other options – Have the Human Resources/Personnel Director contact the Insurance Broker through which the medical insurance was purchased to help advocate your case for you 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” – tips, etc. can be downloaded as pdf file! www.articles.complexchild.com/00012.html
”How To Appeal A Health-Claim Denial – a helpful article from ConsumerAffairs.com on an issue too many JM families deal with! www.consumeraffairs.com/news04/2010/06/health_claim_denials.html
Patient Advocate Foundation (PAF)
The PAF mission is to provide effective mediation and arbitration services to assist patients w/ chronic or life-threatening illnesses with Medical Debt Crisis, Insurance Access Issues & Job Retention Issues. A good resource! www.patientadvocate.org
For access/approval related to IVIG
IGLiving Magazine is an online & print magazine for the IVIG community – www.igliving.com — Kris McFalls, Patient Advocate
FFF Enterprises – Gammaguard, Gamunex, etc. – Click on “Contact Us” – Call “Reimbursement Advisor” — www.fffenterprises.com/Site/ContactUs.aspx
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. www.naic.org/state_web_map.htm
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. www.kff.org/consumerguide/states.cfm
Other helpful Insurance Links
Connecting Kids to Insurance Coverage — www.insurekidsnow.gov/
“Your Health Plan & HIPPA…Making the Law Work for You” — it’s more than simply a privacy law — www.dol.gov/ebsa/publications/yhphipaa.html
“Top 10 Ways to Make Your Health Benefits Work for You” — a helpful link by the Employee Benefits Security Administration of the Dept. of Labor covers HIPAA, COBRA, etc. www.dol.gov/ebsa/publications/10working4you.html
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? www.kaiserhealthnews.org/Stories/2010/September/23/8-changes-health-reform.aspx
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 review the list of covered preventive services available. 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 — insureustoday.org/drupal/PAC
Help 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”. www.genome.gov/11008842
Casey Cares Foundation Financial Aid webpage includes links to helpful resources/tools — www.caseycaresfoundation.orgindex.cfm?page=financial-aid
NeedyMeds – NeedyMeds, a non-profit, was 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. www.needymeds.org
Rx Assist – 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. www.rxassist.org