current cards to all health care providers and pharmacies, ideally before your next visit or claim.
Create a file. Keep statements and receipts in a known area. You may need them to work through authorization processes, claims processes, or, yes, even appeals.
Don’t take short cuts. If you wish to appeal a claim, follow the insurance company’s directions completely and within the timeline they require. Trying to skip steps or bypass procedures will decrease your chances of having a successful appeal.
Save the pretty stationery. Use the proper forms when requested to get your paperwork processed quickly and correctly the first time.
Be a pack-rat. Keep copies of EVERYTHING you submit in the mail. Having this backup gives you the opportunity to be prepared in case the insurance company wishes to go over documents with you in the future. If you use a fax machine, choose a fax machine that prints out a confirmation of receipt message.
Take names. Write down first and last names and titles (job titles, not royal titles) of representatives when you talk to them each time. Some organizations are large, so just knowing “Sue helped me” may not be useful if you are trying to resolve a problem with a separate division. Keep a notepad by the phone, and politely ask them for their identity and title each time you talk. Add the time and date of the call to confirm your records. If you are having problems and need an advocate, contact your State Insurance Commissioner’s Office for advice.
Prepare for open enrollment days. During open enrollment at your workplace, ask insurance company representatives to explain options and provide you with a directory of providers in advance, so you know your choices in terms of physicians, pharmacies, hospitals, diagnostic centers, etc.
Beware of “outsiders.” If you are going to use a provider who is “outside” of your preferred providers, find out in advance how you’ll need to process your claim if your plan will provide partial payment. In addition, some insurance companies partner with specific blood glucose meter companies for better pricing—if you use the preferred meter, you may save some money. Be cautious about taking free meters at health fairs, though, as your insurance company may limit your choices in terms of coverage for strips. Many times out-of-network providers/products will mean out-of-pocket payment from you, up to 100% of the charges. Terms for these providers/products are provided in the policy statement—the little booklet you were supposed to read.
Pre-authorization means pre-pare. Ask your health care providers to perform and complete pre-authorization or notification requirements in advance of appointments and procedures.
Making transitions. Update doctor’s offices, pharmacies, and other health care providers when you have a name change, phone number change, address change, or policy change. In these days of cell phones and work transitions, many people change numbers frequently. If you make a change, notify everyone.
Start Monday mornings. Plan ahead—make inquiry calls as soon as you can. Ideally, call the first of the week, as it may take a day or two to get the information back to you.
Check with new doctors. If you are thinking of changing physicians or pharmacies, check with them to see if they accept your insurance before you make the move.
Know your generic drugs. Remember which drugs are likely only covered as generic versions on your medication policy so that you are not surprised by substitutions. If you must have the trade-name version, find out what you need from your physician to justify the extra expense. If not approved, you will likely have to pay a higher co-pay for trade-name versions.
Renew early. Renew prescriptions BEFORE you run out. This goes for medications, as well as testing supplies, pump supplies, and other health supplies. Many people obtain prescriptions through mail-order services, rather than the local drug store. These services may take several days to process renewals, so don’t be caught without your meds.
Remember your manners. Be patient when working with others; it may take time for things to be processed. To reduce your tension, ask representatives, “When should I expect to…,” which gives them accountability and simultaneously creates a timeline to go on. Of course, don’t let them forget about you—call back if the call is not returned by the timeline you both established.
MORE RESOURCES TO EXPLORE
MAGAZINES, JOURNALS, AND OTHER PUBLICATIONS
Choosing and Using a Health Plan. Agency for Health Care Policy and Research. U.S. Dept of Health and Human Services; AHCPR Publication No. 97-0011.
BOOKS
The Johns Hopkins Guide to Diabetes—For Today and Tomorrow, by CD Saudek, RR Rubin, and CS Shump. The Johns Hopkins University Press; Baltimore, MD. 1997.
current cards to all health care providers and pharmacies, ideally before your next visit or claim.
