TIPS FOR COMMUNICATING WITH YOUR INSURANCE COMPANY
You have the power to knowledgeably pursue all available avenues in obtaining coverage through your health plan benefits.
"There are many different ways to approach the
issue of insurance and medical coverage. Having a chronic illness and
having to deal with insurance and financial issues is one of the most
emotionally draining aspects of PH.
EXTREMELY organized, keeping records of everything. Put it in
chronological order in a notebook - so many questions to answer, and
you need your information in front of you! Keep a listing of all the
contact numbers and make notes about your conversations with the
different agencies, noting person to whom you speak (first and last
names), extensions, times, and dates."
In taking charge of your own healthcare needs, knowing your insurance benefits and communicating effectively will optimize your chances of having your medical care covered. The following easy tips will help you communicate effectively with your insurance company:
- Be confident when calling your insurance company. As a valued customer, you have the right to obtain complete information regarding your health benefits. Your insurance company's customer service representatives are there to assist you. Part of their job includes answering questions to your satisfaction.
- Communicate clearly and calmly. Remember that your ultimate goal is to gain coverage for your healthcare and pulmonary hypertension-related treatments. If you are met with resistance, simply restate your request.
- If at first you don't succeed, try, try again. If you have tried discussing your request with your health plan's customer service representative but are not satisfied with how your insurance matter was handled, ask to speak to
Know your benefits. Health insurance can be complicated. Be sure you know the benefits to which you are entitled under the provisions of your policy. If you do not fully understand something, ask your insurance representative or your employer's benefits administrator.
- a supervisor in the Customer Service department
- the manager or director of Customer Service or Member Services
Document all communication with your insurance company. Be sure to keep detailed, written records of each conversation you have with your insurance company representatives. Record the date the conversation took place, the first and last names of the representative with whom you spoke and make notes regarding any information that was provided to you. Also remember to keep copies of all written correspondence between you and your insurer.
Follow up in writing after speaking with a health plan representative on the phone. Keep your correspondence simple and to the point. Include relevant dates, names of representatives with whom you spoke and their message to you. Also be sure to include your name, policy number and any other identifying information.
Do not hesitate to request assistance from your employer's Human Resources department and your physician(s). In many cases, your employer makes decisions about what will and will not be covered under your health plan. Your employer's support can result in the approval of your request for coverage. In addition, having your physician contact your health plan representative can also be helpful since he/she can speak to the necessity of the requested medical products or services for your overall health.
Carefully follow the steps outlined by your health plan for requesting prior authorization, submitting claims or filing appeals. Otherwise, your request could be delayed or even denied.
Advocate at all levels. Write to your state health insurance commission, Department of Insurance and/or your state and federal elected officials and enlist their help by informing them of your health needs and situation with your health plan insurance claim. Notify your insurance company again that you have requested help from the state Department of Insurance and other agency representatives in resolving difficulties in meeting your healthcare needs.
Utilize the additional resources that are available. There are a variety of organizations that can provide you with assistance with insurance issues. These organizations may be specific to your therapy or specific to your disease state. Remember to enlist their assistance for additional advocacy support.
Be persistent! Remember that a denial is not necessarily the final word. Ask your insurance company to reconsider their decision and follow-up to make sure they are taking action.
Contact us with insurance questions, success stories or suggestions.
PHA is proud to be able to make educational materials and programs like these available for free to everyone because of the generous support from members of the community just like you. Donations are welcome!