When an emergency or new diagnosis occurs, the importance of claim management and organization becomes clear. Multiple providers and layers of care can further complicate the process. If providers misunderstand coverage or insurance rules, clients may be responsible for costly balance bills and penalties. This is why Claims Management is one of the very valuable services Healthcare Pathfinder (HCP) offers. Here are a few tips to help you stay organized:
Register an account with your insurance company. This will allow you to:
- Review the status of claims submitted
- Download and print an ID card
- Find In-Network Providers
- Track deductible and out of pocket expenses
- Access coverage and benefit information
Open your Mail
- Stay current and aware of provider bills.
- Check to make sure bills were submitted to your insurance.
- Receive prompt notification of missed premium payments or denied claims, including your right to appeal (which is time sensitive).
- Be informed of insurance company rules regarding prescription drugs and prior authorization requirements.
When in doubt, seek advice prior to paying balance bills you may not understand.
Below we share a story of how Healthcare Pathfinder’s expertise made an impact in a crisis.
A client sustained serious injuries while skiing out of state. An ambulance transported him to the closest emergency room, and then to another hospital for surgery. Following discharge, the doctor ordered Home Health Care and physical therapy. The bills for care were well into the 5 figures.
Within a week of returning home, he started receiving bills. He called his insurance broker because he was concerned about the bills and what his insurance would cover. His broker suggested calling HCP.
By the time HCP got involved, he had received bills that were not sent to his insurance and multiple balance bills, including a $10,000 bill from the first hospital. The ambulance bills, if paid out of network, were a $6,000 liability. The financial liability was increasing and the process of understanding how payments were determined was overwhelming.
HCP was able to advise on coverage, review bills and claim payments for accuracy, and negotiate reduced payments with providers. We worked with the insurance company to recalculate the claim that should have been processed on an in-network basis because it was an emergency. Without HCP help, the client would have absorbed a significant out-of-pocket expense.
By handing off to a professional what he did not understand and allowing HCP to intervene on his behalf, the client was able to focus on recovery and enjoy peace of mind knowing his coverage and benefits were being maximized to reduce his out of pocket cost. Contact Healthcare Pathfinder if you find yourself struggling to understand your health and/or long care term insurance benefits and claims. [email protected] We ensure clients’ get the coverage and care they deserve, so they can take care of themselves and the ones they love.