Additional Information Regarding Insurance Companies:
Having a preemie also means you will be learning a lot about insurance and paperwork. Although each parent will need to work with their own insurance company to determine available coverage, we have gathered some tips from parents who have had gained experience while working out insurance payments.
The common theme: keep track of the paperwork and always call if you have questions!
You would think that parents of preemies would get a break when bringing home their baby from the hospital it’s not always so! In addition to the medicines, the equipment, the doctor appointments, and oh yeah, the regular baby stuff, you realize you are in the middle of an insurance fight. Just because the hospital is listed as a participating provider in your plan, doesn’t mean that all sections of the hospital are automatically covered under it. Like most preemie parents, you didn’t exactly have time to discuss this upon check-in, right? Right. We’ve been there.
So begins the many phone calls to the insurance company, the various contracted providers that treated you and/or your child in the hospital. And then the dread of seeing what large medical bills showed up in today’s mail.
So what’s a preemie parent to do?
Plenty. While the road to getting all of this resolved has the potential to be long and frustrating and often feel like a second job, you do have rights and you do have people on your side despite what you might at first think.
Here are some quick tips to getting through the confusion:
Breathe In, Breathe Out. Repeat!
Take a deep breath and realize that you are not alone and that you will get through this. Some cases can take up to a year to be totally resolved. Just take it one step at a time.
First off, invest in a simple school notebook so you can keep notes on everything as it progresses. Second, get a large envelope or a set of manila folders so you can divide up the insurance Explanation of Benefits by provider and organize from there. Third, in the inside front cover of the notebook, write up a list of the various providers, their phone numbers, their addresses, and their office hours. Fourth, make copies of your and your child’s insurance cards. Doing all of this can save you a lot of time and aggravation.
Professionalism and Making a Friend Here and There
You are going to be getting to know a few people during this process your providers (the people you and/or your insurance company owe money to), the insurance company (the customer service team to the appeals team). The providers are your friends, believe it or not. They want to make sure their company gets that big check so chances are that they have not only been through this before with other patients but also they may have some sort of template appeals letter they can provide to you. At the very least you will get to know them and they will get to know you. All conversations with the provider should be polite and professional. Make sure that as you update your notebook with notes on conversations with the insurance company, etc. that you are doing the same by updating the provider in question. That way you become less of an account number and more of a human being.
The insurance company on the other hand, will do its best to confuse the life out of you. Every time you call into the customer service department, be prepared to wait on hold for a bit (if you have a speakerphone at home or work, use it!) Use this time to prepare your set of questions, collect all documents necessary to the subject at hand, etc.
That way when you do talk to a representative, you are ready to go. If you are calling to question the way a claim was handled, simply ask them to go over the claim in detail with you. After all you are the customer, they should be telling you what they did and not vice versa.
This is very important. Take notes on each and every phone call and make sure to include the date, time and the person you spoke to (ask for full name and be clear you need a correct spelling of the name). That is where your notebook comes in real handy. That way all notes stay in one place and you have a chronological log of all discussions.
What this will do is help you work through the confusion of the insurance company. Yes, they want you to get confused and to just give up. That is what they are hoping for. Don’t give up!
Persistence Pays Off
You have the right to challenge a denied claim, so if a simple phone call to the insurance company won’t work then move onto writing an appeal letter.
Again these letters may already be on hand through your doctor’s office.
Give them a call to check and see if they could assist you with the letter.
Along with the letter itself, make sure to reference any and all claim numbers and to also provide copies of the Explanation of Benefits for each
The above information has been reprinted with permission from one of our Spotlight Preemie Support Groups: Preemies Today http://www.preemiestoday.com/index.html
P.O. Box 306
East Islip, NY 11730