I was diagnosed with breast cancer in November 2011. Since my initial diagnosis, I have racked up considerable medical bills. It seems like I need a full-time employee to deal with my insurance claims. This has been a learning experience. Staying organized and knowing what your insurance plan covers is crucial to prevent overpaying.
Know your insurance plan
With my particular plan, I have separate deductibles and out-of-pocket maximums for in-network and out-of-network doctors and facilities. The difference is huge. Out-of-network has double the deductible of in-network and the out-of-pocket maximum is doubled. The coinsurance payment drops from 80 percent for in-network to 60 for out-of-network. Carefully selecting my physicians and treatment facilities can save me a lot of money.
What do those terms mean?
Here is a quick breakdown of common health insurance terms that you will see on your policy. It pays to memorize the terms. You will need to know them to properly understand what your financial responsibility will be.
Deductible - the amount of money you have to pay out before your insurance company pays any benefits.
Out-of-pocket maximum - the maximum amount of money you will be responsible for paying. If your plan has this benefit, once you meet the maximum, the insurance company will pay 100 percent of your covered medical bills.
Co-payment - the amount of money you are expected to pay when you visit a doctor, hospital or other facility. This is in addition to any charges you may incur.
Coinsurance - this is where your health insurance pays a percentage of the covered medical bills. In many cases it can be from 60 to 80 percent. Coinsurance is in effect from the time you meet your deductible until the time you reach the out-of-pocket maximum on your policy.
Coordination of benefits - if you are covered under more than one health insurance policy, you need to fill out a coordination of benefits with the primary and secondary insurance carriers. Anything that is not covered by your primary insurance can be submitted to the secondary insurance for payment.
Explanation of benefits - this is a form sent to you by your insurance company that explains what they have paid, what they will not pay, what is covered and what is not covered. It will also tell you if the provider is in-network or out-of-network.
Keeping records straight
I have a separate pocket folder for all of my medical bills. On one side of the folder, I put unpaid bills. On the other side I put the paid bills. I use clear sheet protectors to store lab reports, letters, payment arrangements and other documents. The sheet protectors are secured in the folder between the two pockets.
Use online access when possible
Most insurance companies have online access to your account. Using this access you can see which claims are being processed and which are still open. Many times you can see the processed claims before you get a bill from the provider.
Some health care providers have Internet access to your account. Mercy Health Systems and the Cancer Treatment Centers of America have this feature. I can access my bills, manage appointments, see limited amounts of medical records, request prescription refills, and ask general questions.
I find using the online access helps me to keep on top of things. Many times an insurance claim will be processed, adjusted and reprocessed. I can ask questions about payments and coverage. I saved over $800 when I questioned the charges for my initial diagnostic mammogram. My plan is supposed to cover the first mammogram of each year under preventative services. I sent in a question about this and the insurance company agreed. The claim was reprocessed and I owed nothing for the visit.
Call your insurance company to determine breast cancer benefits
Your insurance policy may not detail all of the benefits available to you as a breast cancer patient. Items like wigs, breast prosthesis, special bras and camisoles may be covered. Other services that your insurance company may pay for is home health care. If you have a tram-flam for breast reconstruction, you may require a lot of help at home during your recovery. Knowing your specific cancer benefits will enable you to be more comfortable during treatment and breast reconstruction.
Empower yourself by staying organized and knowing your health care coverage. This will allow you to make the best medical choices possible without going broke. Find a filing system that works for you and stay organized.
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