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Healthcare Headaches Ruining Your Life?

November 7, 2014

 

Hey, you! Yeah, we're talking to you! All of you who work a full-time job and care for a loved one in your “spare” time. Those left with anxiety and guilt, after listening to voicemail messages from distant parents who insist they’re still fine on their own. Those of you exhausted from managing your own care; tired of battling your primary care doctor’s office to put through your referral; those frustrated by the contradictory statements and billing letters from your various medical providers. You’re who we’re here to help; it’s why we’re talking to you. Here’s a look at a few situations that CarePartner helped with that we’re sure you relate to:

 

1. The insurance company is out to get you. Before you claim the insurance is out for blood, literally, ask yourself some questions like those we asked of Ben when he got billed for a procedure that he was told was considered a ‘routine colonoscopy.’ When you look at the fine print of your benefits booklet, it may say that ‘a colonoscopy has to be billed as ‘routine or screening’ in ordered to be paid 100% by the insurance. Unfortunately, when a medical concern is found (polyp, bleeding, etc.), a medical claim must be submitted as ‘diagnostic’, which usually applies against your policy’s deductible and coinsurance. When we looked into Ben’s case, it became clear the doctor’s office submitted an incorrect diagnosis code. Once we clarified the issue, the doctor’s office submitted a corrected claim that qualified the plans screening colonoscopy at 100%. Know your benefits; know your risks.

 

2. To pay, or not to pay? Cancer. As if the diagnosis wasn’t tough enough, Rich found his kitchen table featuring a most unique centerpiece of stacked medical bills and benefit explanation statements. He turned to CarePartner when he needed help clarifying what bills he owed and ensuring all medical claims were correctly applied against his out of pocket maximums (his deductible and coinsurance). We not only organized his bills and printed a working spreadsheet to simplify what he owed. We also contacted one of the billing departments on his behalf to request a ’30-day hold on the account, to allow the insurance time to process a corrected claim. We also kept Rich calm and reassured when he got a call stating he needed to pay $14,000 before his next chemotherapy appointment. Since we were aware of his already having met his out of pocket maximums for the year, we were able to correct the billing unit to advise our client owed $0. Rich up to that point had told us he’d be willing to forego lifesaving medical treatment because of cost!

 

3. You’ve said any of the following regarding your health care situation: “My situation is impossible. There’s no hope. Nobody cares. Bad stuff always happens to me. I’m about to pull my hair out. I’m so depressed.” There are times when we speak to prospective clients when we know it’s not a good fit for you nor for us. Although we know our services make a tremendous impact, trust is an essential to our partnership. Just today, I spoke with Lynne whose daughter suffered an acute injury. Because there were concerns from the hospital on whether on her adult daughter’s insurance was active or not, Lynne paid upfront $54,000! Months later when the insurance and hospital were able to get all claims successfully processed, the hospital acknowledged that Lynne’s money was to be reimbursed. I listened as this mother cried, both profoundly frustrated with the hospital, feeling let down by people who leave her on hold nor call her back when they promised. She wasn’t ready to make that step to allow CarePartner to advocate. So I armed her with some helpful strategies to see her situation through.

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