Advocacy and Patient Education Roadmaps
Below are excerpts from our roadmaps, which are available for download in full text. For your free copy, contact us today.
What to Do with a Denied Claim
Receiving the news of denial of coverage of an insurance claim can be an enormous shock, especially if the claim is a large one. However, you should never assume that “no means no” as far as your insurance coverage is concerned. Appeals are successful in getting claims covered almost 50% of the time, so you should always determine why a claim was denied and follow the process to appeal. Time is of the essence, however, since many insurance companies have a short period under which you can file an appeal.
Understand Your Insurance Coverage
Health insurance is complicated. You must understand the details of your own health insurance coverage if you hope to maximize your coverage and minimize your out-of-pocket costs. You must learn the language of health insurance.
Glossary of Common Insurance Terms
Admitting Privileges: The right granted to a doctor to admit patients to a particular hospital.. Advocacy: Any activity done to help a person or group to get something the person or group needs or wants. Agent: Licensed salesperson who represents one or more health insurance companies and offers their products to consumers. Benefit: Amount payable [...]
Make the Most of Your Prescription Drug Plan
When choosing a health insurance plan, it’s just as important to make sure the medicines you take regularly are covered as it is to know that your doctor is covered. Selecting the right prescription coverage for you and your family is important to maintaining and restoring your health while managing costs. For those without drug insurance, there are many organizations that can help.
Filing an Insurance Claim Step by Step
Step 1: To receive your health insurance benefits, you or your doctor must file a claim with the insurance provider. If your doctor is in the plan’s network, his office will generally file the claim for you. If you see a doctor outside the plan’s network, you will probably have to file the claim yourself. Some providers, especially mental health professionals, are outside of any insurance plan, in which you will always have to file the claim yourself, and expect to pay more out-of-pocket.
Successful Medical Communication
Being diagnosed with a serious illness is a frightening experience. It is important that you research and educate yourself about your disease and learn to communicate with your medical team. An informed patient gets better results. Here’s how:
Taking Care of You
Doctors and other members of the health-care team should regularly assess a patient’s emotional and social needs, and then ensure that the patient is linked to appropriate resources. In reality, though, most do not have the time or staff resources to manage the psycho-social needs of a seriously ill person. Our roadmap series weaves together for you a coherent approach to managing your situation so that you can focus on treatment, healing and recovery.
Evaluate Health Information on the Internet
Avoiding information overload and finding credible, reliable information is difficult. Internet content is not regulated, so you need to be a knowledgeable consumer when you are searching for information about cancer or other diseases. Consider the following questions when viewing health information websites:
Stay Safe in the Hospital
Preventable hospital hazards claim almost 300,000 in America every year. Another 3,700,000 Americans are harmed, but survive. Most of these deaths and injury are among older patients, and most are the result of a strained health care system seriously short on nurses and other critical resources. You have to manage your hospital stay as if your life depended on it.
Manage Your Medical Records
You must learn to be your own best health care advocate. Like it or not, a big part of effectively managing your health care is organizing your medical records. Whether you wish to seek a second opinion or enroll in a clinical trial, being prepared is essential.