“If you feel like you are drowning in paperwork, there are things you can do to regain control. If you don’t, those stacks of paper will cause you serious problems that could have been avoided.” Elisabeth Russell, President, Patient Navigator

Your Dilemma…

You have stacks of medical reports, bills, insurance statements, claim forms, and payment records piling up and causing you stress. Piles of disorganized paper (and electronic records) can surely intimidate any patient.

If you ignore the paper, you might not take necessary medical actions or you could fail to maximize your insurance benefits. If you want to minimize personal overpayment, optimize your benefits and ensure accuracy in treatments, you must organize these important documents into a user-friendly system.

Our unique “My Patient Navigator™ Insurance Tracker” online tool is available to you as a member. Or, you may also choose to have your personal navigator take care of this time-consuming and stressful task for you. Ask your navigator about this option.

Your Roadmap…

Step 1: Know thyself.

Are you organized by nature and the type of person who immediately opens and categorizes her mail? Or do you hope the paperwork will go away if you ignore it long enough? Are you somewhere in between?

You must answer this question honestly so that you can build a record-keeping system that works for you. It should be easy and intuitive to the way you manage paper. Some people prefer to organize by type of medical condition, others by medical provider, and still others prefer a chronological order. You can use a three-ring binder, file folders or put your records into your computer. The key is that you will USE the system you create.

All these are valid, provided the method chosen is used consistently. Also, if the records are particularly complex, it is helpful to list the different items in a computerized spreadsheet, which helps track items as they are reviewed. Color coding records for different patients and/or different providers is also helpful.

Navigator Tip:

If you have a friend or family member to help you manage your medical financial paperwork, let them! This is an overwhelming and stressful part of your journey through illness. If you can delegate this task to someone you trust, you will benefit. Patient Navigator, LLC offers an individualized medical financial records management service.  Ask your navigator for more information.

Answer These Questions As You Begin

  • What are the immediate or outstanding actions I need to take regarding medical treatment or follow-up care? (Doctor visits, obtaining test results, scheduling tests)
  • Which outstanding medical bills do I need to pay (those that have already been processed by insurance)?
  • Which outstanding bills do I need to submit to insurance for payment or reimbursement?
  • Do I prefer to organize:
    • By Date of Service
    • By Heath Care Provider
    • By Medical Condition?
  • How many patient records need to be organized?
  • Do I need to see the data summarized at a glance?

Step 2: Evaluate Priorities

The next thing to do is to determine the extent of the problem and then break it down into manageable steps.

  • Do the records pertain to a critical medical issue?

If yes, these are the ones that need to be organized first, in order to account for all aspects of care for the urgent medical condition.

If no, then proceed with all data by relative importance.

  • Are there long-term outstanding amounts owed to healthcare providers?
  • Are there claims that need to be submitted to insurance companies to reimburse you for amounts already paid?
  • If yes to either one of these questions, complete the paperwork to address payment or collection immediately.
  • If there are numerous outstanding claims for insurance payment that have not been submitted, send them in to the insurance company! They probably owe you money.

Please review our “Find Financial and Practical Assistance” roadmap for more information on how to pay for medical expenses.

Be aware that many insurance companies have strict deadlines, depending on the date of service, for when new claims can be submitted or appealed. Don’t miss the window. Read your insurance policy carefully.

Step 3: Action!

  • A. Clear a workspace.
  • B. Gather the tools needed (notebooks, sheet protectors, file folders, calculator, sticky notepads, pencil/pens, highlighter, stapler, tape, paper clips, stamps, envelopes)
  • C. Set up computer, if recording information electronically
  • D. Gather all the data pertinent to the top priority item (medical actions, insurance submissions, payments to doctors)
  • E. Sort the papers into bundles related to organization methodology chosen (by date of service, service provider, etc).
  1. Take care to account for all paperwork from all sources. There may be a day-of-service record, several invoices, An Explanation of Benefits (EOB) from one or more insurance companies
  2. It may be necessary to compare services by date-of service, because different terminology may be used on different paperwork. For example, a line item in a hospital statement shown as “Chest X-ray, may be detailed on an insurance Explanation of Benefits form as “radiology”.
  3. If there has been an appeal, or re-submission of payment request, be sure to note whether it was successful. The record number will likely be different. You need to figure out the jigsaw puzzle.

Step 4: Closing the Loops

Remember that at the end of the process, the services rendered, billing, invoice, co-pays, deductibles, insurance payments numbers should match up and make sense. You MUST scrutinize each doctor bill, insurance benefits form, and hospital bill for accuracy.

If you do not understand a particular charge, call the billing office of the provider. Sometimes insurance claims are denied simply because the doctor’s office submitted the WRONG diagnostic or billing code.

If an insurance claim is denied, don’t just give up.  Find out why!  Our  “What to Do with a Denied Claim” roadmap will show you the way.  Call the insurance company and ask them the specific reason why and then follow-up.

You can also ask your navigator for help with insurance problems.  It is a service available to members of the My Patient Navigator network.