Most cancer caregivers don't have a good idea of what their loved one's insurance covers until the need arises. And then we have to learn to be proactive in working with doctor's and hospitals to make sure charges are covered before they are incurred.
Insurance, claim and bill management can be a very frustrating process. It's important to recognize that most hospitals, doctors offices, and treatment centers will provide an advocate or insurance services representative to assist you. You should always ask who these individuals are, and ask them for assistance. They usually have a more comprehensive knowledge of the insurance system and often provide insight and recommendations that you might not be aware of.
Tips
1. Get a physical copy of your loved one's insurance policy and find out exactly what their coverage includes. Make sure and look at traditional health coverage (hospital stays, doctor's visits, surgery, etc.) as well as alternative or complimentary medicine (massage, acupuncture, etc.)
2. Thoroughly review the policy and then call the health insurance provider to answer any questions that you may have. Look out for inconsistencies or vaguely described benefits. Do not let your insurance company deny coverage for something that has been covered in the past or that you believe should be covered.
3. Make sure you are aware of any possible coverage issues before you start any treatment. The doctor's office will usually do this for you, but make sure you are in contact with them and know what the coverage is for each treatment ahead of time.
4. Many insurance companies now offer online access to all claims and communications, check out if yours does or plans to. While this won't alleviate the need for your own record keeping, it does make it easier and acts as a double check for lost or delayed claims.
5. Keep careful records of all your covered expenses, claims, denials and appeals throughout the claims process.
6. Take thorough notes during your conversations with insurance representatives. Include their names and job titles, and the date(s) you spoke with them. Keep these notes with your records. If you don't get the answers you need, be your own advocate and ask to speak to their supervisor!
7. A spouse is legally responsible for your loved one's bills and your income is included in determining eligibility for Medicaid. Unmarried couples may find it easier to get Medicaid benefits which may include home health care.
8. If a claim is denied, talk to your health insurance provider to find out what steps you can take to appeal. The following sites will help you understand and navigate the insurance questions that you will face. You should also check with your doctor / hospital and inquire about their advocacy programs in support of insurance questions and follow through.
Remember: The goal is to get the maximum benefit from your loved one's insurance policy!
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