By Martine G.Brousse
Patient Advocate, AdvimedPro
January 11, 2022
When interacting with your insurance, it often feels like the quickest way to a live representative is to ask is frequently to refer you back to your policy... and square one.
But what if your insurance policy provided real answers, and also free resources or low-cost services that may not only save you money but also lower frustration and confusion?
Even though they vary in scope, here are eight commonly accessible programs. Contact your insurer for the ones specifically offered to you, or visit your online account.
1. Case Managers
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 can educate you on your condition, provide you with informative and educational material, advise you on concrete steps toward recovery and answer clinical questions.
Your case manager can also review your insurance benefits, expedite the authorization process or inform you of your rights (to an appeal for example). 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 a referral for a second opinion consultation or other specialists.
The case manager may also help with billing and claim processing issues, especially if those would delay your treatment or getting an appointment.
2. Health Assessment
Online questions for your fitness evaluation may guide you to learn more 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 (usually free) preventive screening is in order.
3. Health Library
As insurers are never as happy as when you don't use their services, 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 the cure for baby rash or the best exercises to ease back pain, 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 nurses at the 24/7 helpline can advise you on all kinds of acute but not life-threatening symptoms, and on whether medical attention or emergency care should be sought. They may access your records, 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 for help with the mail order company.
5. Share of cost estimations
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.
Since the Covid pandemic of 2019, a number of plans have implemented teledoc services for medical and mental heath. Those are often free of charge to members. Online appointments can be made through your member portal, and can save you a trip, a chunk of time and a good deal of cash.
These services are often overlooked or even unknown by patients left scrambling for information, assistance or lower costs.
Your insurance policy, HR insurance relation person or online portal will be great assets to consult, from preventive care to life-threatening situations.
@ Martine G. Brousse 2022