By Martine G. Brousse
"The Medical Bill Whisperer"
Patient Advocate, Certified Mediator
Watch the video: https://youtu.be/N7qkRR_Arak
Oct 30, 2023
As this year is (already) running out, there are some things that patients should be awake of.
Taking action before and right after dec 31st can save you money, and bad surprises.
Here’s your End of the Year checklist:
A. Before 12/31:
1. Get your appointments in
· Preventive care check-ups (free)
· Well visits for you and your kids (free)
· Follow-ups you’ve been avoiding or too busy to schedule
2. Maximize your met Share of Cost
· If your deductible has been met, your insurance will pay a good portion of your claims
· If your whole Co-insurance or Out Of Pocket has been met, your insurance will pay 100% of your (In Network) claims
3. Get your Rx refills
· At your pharmacy
· Via mail order (usually 3 months’ worth)
B. In early January
1. Transfer your Authorizations
· Unless your plan is the same, you will need to transfer any 2023 authorization to your new plan to avoid denial of payment, or payment at the wrong rate by your new insurance
· Whoever requested – and obtained – the original authorization should ask for the transfer
· Note: If you have not yet used an authorization, its transfer may be denied if the provider is now Out Of Network
2. Get a (new) PCP and/or Specialists
· If your plan is new, or with another insurance, make sure your current physicians either belong to this new network, or consult the online provider list to pick a new one. The insurance phone reps can also send you an In Network provider list.
3. Continuation Of Care provision
· If you are undergoing a treatment that cannot be delayed (chemo for example) or if transferring care requires a bit of time to be deemed “safe” (i.e.not detrimental to your physical or mental welfare), the provider (or you) should request a “continuation of care” authorization
· This means that you could continue the current course of treatment with your current provider, if and especially if the provider is now Out of Network
· Once the treatment is completed, or a transfer deemed “safe”, your care can/should be transferred to an In Network provider
· Some insurers (Kaiser comes to mind) will determine they can offer the same level of care as your current provider, and insist on your transferring care, regardless of the consequences to you. Do NOT allow this if not in your best interest!
· Communicate any insurance coverage change to all your providers ASAP, including send a copy of the card, even if you don’t have an appointment set up. It will avoid delays in payment, and potential bad surprises later in the year
· Submit your out of network claims: you never know what may be reimbursed
· I always audit my claims list which I download from the online insurance portal. I can spot errors and get claims reprocessed before untimeliness becomes an issue.
· Downloading this list also can help calculate my medical expenses when tax filing time rolls around.
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
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@martine brousse 2023 @ the medical bill whisperer 2023