As if fighting the battle against the Cancer Beast wasn’t enough, last year our mailbox was literally flooded with doctor’s bills & EOBs (Explanation of Benefits) from our insurance company. It was downright overwhelming. And guess what? Many of the bills & EOBs were WRONG, WRONG, WRONG! I couldn’t take it… I was helping manage Alan’s care, arguing with certain clueless doctors & raising 3 kids. I needed help…which BTW was not easy for me to admit…
Thank G-d for Alan’s sister Sue. She might come across as a sweetheart, but make no mistake about it, she’s smart, savvy & you don’t want to make her mad!
Sue did so many, many, many amazing things last year to help us… but one of the most important things she did was manage the insurance bills. I asked Sue to write up her advice on handling the insurance & medical bills… So without further ado, here’s…Sue’s Advice on Managing Insurance & Medical Bills (take it from me, she knows what she’s talking about):
1. Appoint an insurance advocate. Ask a competent & detailed oriented family member or friend to handle all issues relating to medical insurance. You will need to fill out a HIPA document with each doctor/provider as well as the insurance company. (BTW, off the record, there were several times where we forgot to have the HIPA forms signed so Sue told a little white lie and pretended to be me… she knows all the personal information required to be me… I loved it when she broke the rules. 🙂 )
It always helps when your advocate is well versed in your specific medical situation. Following Sue’s footsteps, I suggested my cousin find the best Hernia Mesh Lawyers in New Jersey to handle her medical malpractice case right after her Inguinal Hernia repair. It saved her time and more importantly money!
2. Ask the advocate to take a few minutes to understand patient benefits & get familiar with how to use the insurance company’s website especially the claims section, appeals procedures & medical policy bulletins.
3. Have the advocate review every EOB & every bill carefully! All it takes is for a claim to have an error in the CPT code, diagnosis code, or pre-certification code & the thing will not get paid. Know WHY the claim was denied! Is it a processing error or a non-covered benefit? Again, tons of our bills came in WRONG… if Alan & Robyn had just blindly paid them without question, the thousands of dollars they spent would have turned into tens of thousands or more.
4. Call the Member Services department of your insurance company & DEMAND that a Case Manager be assigned to you. Our Case Manager was an amazing RN named Kara. She was tremendously helpful in finding providers, smoothing out the hospital discharge process, setting up inpatient/outpatient therapy, and supporting us through pre-certification & appeals of drugs or procedures. She was a miracle worker… a true angel. Plus we no longer needed to call some random call center & speak to rep who had no clue about our case. We no longer had to repeat our entire & exhausting story yet again. We had a direct line to someone who knew her stuff & she was there for us 100%.
5. Take copious notes whenever you speak to any doctor’s office or insurance rep about a claim… including but not limited to: date & time of conversation, name of person that you are speaking to & their contact info, specific details of the conversation & any follow up that is required.
6. Buy a fax machine. Due to HIPA laws, most doctors offices do not use email… every correspondence must be faxed…. which is beyond frustrating & annoying in this age of technological advances.
7. If all else fails, NEGOTIATE! I haven’t met a doctor’s office or hospital yet who isn’t willing to negotiate. There are even companies who specialize in this exact thing. Also, should you need to see a doctor that is out-of-network, talk to that Office Manager about making a deal. Put on your best smile… and use the sympathy card… it works! And it’s legit!!!