Medical Bills and Insurance

…Not a guarantee of payment. Huh?

Your doctor recommends a test or procedure. You’re a wise consumer. You ask your doctor or hospital to pre-authorize coverage, or maybe you even get the codes they will use to bill and call your insurer yourself. You get a pre-authorization reference number or a letter, but somewhere in the documents is a statement that …

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Health Insurance Open Enrollment: Trick or Treat

Some people think of October as Trick or Treat time; Patient Advocates see it as the kickoff of health insurance open enrollment for the coming year, whether employer-sponsored, individual, and/or Medicare.   It may not be as playful as donning a costume or carving a jack o’lantern, but approaching your open enrollment period with the …

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Emergency

Emergency. Dictionary.com defines it this way: “a sudden, urgent, usually unexpected occurrence or occasion requiring immediate action. “ In my healthcare experience lifetime, perhaps nothing has changed more than the role of the hospital emergency room. In my youth the hospital had two roles: caring for very ill or post-surgery patients needing nursing care until …

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In or Out, Round About – Navigating Out of Network Providers

Health insurance is complicated and healthcare costs a lot. If you’re not up for a complicated read, here’s the short version: Don’t use out of network providers if you can avoid it. If you think healthcare is expensive, out of network healthcare is very expensive! But if you want to dig a bit deeper, read …

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Does Insurance Cover That?

Inevitably when I’m asked what I do and respond that I’m a private patient advocate, one eyebrow raises, followed by “What’s that?” My “Private Patient Advocate” elevator speech goes something like this: “Private patient advocates are independent professionals that help patients and their families clarify options for managing their healthcare as well as the cost …

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Before you jump in…Re-thinking preventive health screening

An advertisement arrived in my mail recently from a local hospital system offering a special promotion on  “heart disease, stroke, and aneurysm prevention package testing.” The tests included were extensive, and the mailing screamed not to wait to schedule these “life-saving screenings.” And, by the way, these tests are normally valued at over $2100 but …

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Caveat Emptor! (Or…a new twist in paying for healthcare)

Monica* had driven herself to the emergency room at a local hospital late at night after experiencing severe abdominal pain. She was worried she might have appendicitis, and her insurance company nurse line had advised her to go to the emergency room. A CT scan, MRI, and blood work were ordered, and intravenous pain medication …

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