FINANCIAL & INSURANCE INFORMATION

How to Avoid Problems with Your Medical Providers and Insurance Companies

1.  GET PRE-APPROVED...IN WRITING...FROM YOUR INSURERS, PRIOR TO AGREEING TO ANY EXPENSIVE TREATMENTS, TESTS OR MEDICATIONS!

Get your procedures and tests and medications PRE-APPROVED by your insurance provider(s).  Demand a written pre-approval and claim number.  DO NOT ACCEPT THIS STATEMENT FROM ANYONE:   "Don't worry about the insurance coverage...we'll take care of it!"  Too many cases of denied claims have happened after doctors, nurses, or other administrative staff persons reassure the patient that all the procedures, tests, etc. will be covered.  Don't fall into this trap!  Get your doctor to request a pre-approval for coverage in all cases where there is any major expense to be incurred.  As one of our members put it, "If your claim is denied, the doctor or nurse or other party is not going to pay the bill.  You may be liable for all charges if you do not get a pre-approval."

2.  Ask if your doctor's recommended treatment is "FDA approved for your condition"!

 Many insurers will not provide coverage for "experimental" procedures, medications, etc.

3.  Know and confirm your insurance coverages!

Do you have deductibles, co-pays, or other terms that will cause you to be responsible for some or all of the costs you are incurring?  Does your insurer list your doctors and hospitals in their network?  Even if you think you have determined that the insurance should cover your request, call the insurers and double check what you may be charged for.  To quote one of our members, "We incurred $10,000 in "out-of-network" charges before the claims forms started arriving that showed we were "out-of-network" for all charges we had incurred over a two month period of time.  We had no clue that this was the case!  It wiped out most of our savings which now gives us fewer choices about our medical care."

4.  Take advantage of social workers and financial advisory services offered by your doctor or hospital.

These folks can assess your coverages, recommend actions that can protect your financial situation, and in general help you decipher your options!

5.  If your insurance claim is denied... FIGHT BACK!  Appeal those denials.

Remember insurance companies are in the business of making money for their investors.  It unfortunately is not in their best interest to pay claims, though that is the reason most of us put out big bucks for their coverage.  A denial should be viewed as a request for more and better information.  Most insurance companies provide information on how to appeal denials for coverage of claims.  Look in the information packets you received from your provider.  If you do not have this information, request it from your insurance provider.  

 If  you have exhausted your appeal process with your insurance provider and still do not have your claim approved or reimbursed, you can take your case to your state's insurance regulators. 

Be sure to document your claim with information from experts, your doctors and examples of other claims paid for similar requests (yours or another patient's).  

 Laurie Todd has written a book FIGHT YOUR HEALTH INSURER AND WIN - SECRETS OF THE INSURANCE WARRIOR about how to get your insurance company to pay even if they have denied payment.  You can get more information about her book and tips and suggestions by visiting the following sites:

 YouTube Interview with Laurie

 Laurie's Suggestions Published on the Carcinoid Cancer Foundation website.

 To purchase Laurie’s book and CD, click here:  http://theinsurancewarrior.com/thebookandthecd.html

State Insurance Regulators

Remember:  The state regulator for your area is a taxpayer paid service.  Call them or use them to file an appeal for insurance company denials.

Social Security Disability

 Benefits for Persons with Disabilities

Medicare

The Official Government Site for People with Medicare

Medicaid

Medicaid is a state administered program for providing medical assistance to low income and other medically challenged patients.  Assistance can vary from assistance with co-pays and deductibles under other programs to full medical care.  Requirements for this service vary from state to state.  Check your state's requirements, download applications and get more information below:

ANY STATE/MULTIPLE SERVICES:

CMS Centers for Medicare and Medicaid Services - Contacts Database

Kansas: 

Department of Social and Rehabilitation Services of Kansas

Missouri: 

Department of Social Services of Missouri - MO HealthNet Division

Nebraska:

Nebraska Department of Health and Human Services System

Iowa:

Department of Human Services of Iowa

Oklahoma:

Health Care Authority of Oklahoma

Tennessee:

Bureau of TennCare

Recommended Reading:

FIGHT YOUR HEALTH INSURER AND WIN - Secrets of the Insurance Warrior by Laurie Todd

THE CANCER SURVIVAL TOOLBOX by the National Coalition for Cancer Survivorship - available FREE - Click Here!

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Financial Aid Resources

 The Lois Merrill Foundation -  Offers Medical Assistance Grants based on financial need to cover costs of treatment for NETs.

For assistance with drug costs not covered by insurance, contact the Manufacturer of the drugs.  Many pharmaceutical companies are making expensive drugs free or affordable for those who cannot afford their medicines.