Patient Advocacy: Healthcare on your side
by Martine G. Brousse,
Healthcare
Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO
FREE SERVICES by
YOUR HEALTH INSURANCE POLICY
When interacting with your insurance, it often feels like
the quickest way to a live representative is to want to pay your premium. Their usual default response to whatever question you were calling about 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?
Well, most if not all of them, do. Even though they vary in scope,
here are eight commonly accessible programs. Contact your insurer 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 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 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 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 way to
ease back pain 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 nurses at the 24/7 helpline
can advise you on all kinds of acute but not life-threatening symptoms, and on whether
or how soon medical attention 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 help with getting prescriptions through the preferred 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.
Some systems list both "in network" and "out
of network" figures.
6. Store you health records
Major carriers offer upload capacity for your health
records. You may indicate 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 history is available too.
8. Discount Programs
More or less extensive depending on the insurance, coupons
and discounts programs can be found on websites. 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.
Aetna uses the LifeMart shopping site, also proposing
non-health related products. Other insurers like Anthem offer coupons to be
used directly with each merchant.
Check out prescription coupons too. Why pay full price when
a discount card or assistance program might be 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!
© [2016] Advimedpro.
© [2016] Martine G. Brousse.
All rights reserved.
My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.
AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330
