By Martine G. Brousse
"The Medical Bill Whisperer... and insurance stuff too"
Patient Advocate, Certified Mediator
June 5, 2023
Interacting with your insurance is stressful, irritating and too often a waste of time. I know, that's my job.
But what if your insurance policy provided free resources or low-cost services that may not only save you money but also lower frustration and confusion?
Well, most if not all of them, do. Even though they vary in scope, here are eight commonly accessible programs. Contact your insurer or visit your online portal for the ones specifically offered to you.
1. Case Manager/RN
More often used in case of a chronic, serious or life-threatening diagnosis, a case manager works as a liaison between your physician(s), insurance and pharmacy. Your assigned case nurse will provide you with informative and educational material, advise you on concrete steps toward recovery and answer clinical questions.
She/he can review your insurance benefits & expedite the authorization process. You may call for clarification on prescribed medications or treatment, or for questions that do not require a visit to your doctor. You may also request to be set up for a second opinion or a visit to another specialist.
2. Health Assessment
Use the online portal fitness evaluation questionnaire to guide you about what constitute normal levels and readings for your age group. You might be directed to a physician or prompted to evaluate your lifestyle for healthier choices. You might find out some vaccinations are overdue, or that a preventive screening is in order.
3. Health Library
As insurers are never as happy as when you don't use your policy, you will find lots of health-enhancing articles and brochures online. In accordance with the mandate of the ACA ("Obamacare"), preventive medicine and patient education and involvement are now prioritized. Easy and direct access to health information will become more and more the norm rather than seeking medical care without discrimination.
Whether you need a remedy for baby colic or the best way to ease exercise pains without medication, the health library likely has an answer. Check out fact sheets on all kinds of health topics there.
4. Nurse line
Though not "assigned case managers", the 24/7 helpline can advise you on all kinds of acute events, and on whether or how soon medical attention should be sought. whether of a medical or mental health nature. They can order a refill, recommend over the counter remedies or give you basic first aid steps. Ask them to recommend a specialist within your network or help with getting prescriptions through the preferred mail order company, especially after hours.
5. Share of cost estimates
Some systems might require a specific CPT (procedure) code, but most have a listing of common services such as ER or office visits, imaging, labs, surgical interventions, disease management or injury treatments. Based on your Zip code and type of policy, the quote can be for a one-time event or a yearly average.
Some systems list both "in network" and "out of network" cost estimates.
6. Store you health records
Major carriers offer upload capacity for your health records. You may record appointments, list medications and include personal or family history. Available to you and your doctor via a sister app or online, records can be viewed anywhere anytime.
Your claim and Rx history is available too.
7. Discount Programs
More or less extensive depending on the insurance, coupons and discounts programs can be found on your portal. From home blood pressure monitors to contact lenses to gym memberships to wellness programs, these savings could be worth a bunch.
Vision, hearing and dental services, even if not part of your benefits, may be accessible at lower cost through preferred vendors.
Check out prescription coupons, too. Why pay full price when a discount card or assistance program is available?
Whether you or your employer pay your premiums, why not take full advantage of the many free or reduced-cost services your policy offers? Start with creating an account on the insurance website, then check out all "patient" tabs. Make sure you look up cost estimates and calculate your liability before any major test or intervention. A good preparation can save you $ too!
Martine Brousse, the "medical bill whisperer" is a Patient Advocate and Certified Mediator located in CA and the founder of AdvimedPro, which she started after 20 years as a billing manager for physicians.
@ Martine G. Brousse 2023
@the medical bill whisperer 2023