Families can feel overwhelmed when trying to understand the complexities of insurance coverage. Here are some things you can do to try to minimize insurance problems.
- Know the type of plan. Call the insurance company to find out whether a specific doctor is approved to treat your child, what hospitals or clinics your child can go to, and how to get authorization for your child to see a specialist or someone out of the network.
- Set up a recordkeeping system. Record dates of services (clinic visits, lab visits, surgeries, hospital admissions, tests, scans, consultations, emergency room visits) and names of healthcare providers.
- Get and keep a copy all authorizations. These include authorization forms; also check dates of these authorizations. If a child will be seen regularly at a clinic, or will require the same tests, labs, etc., on a regular basis, ask for an extended authorization rather than single-visit authorizations. If a clinic visit or hospital admission is delayed, the original authorization may no longer be valid. It may be necessary to get a new authorization.
- Keep all Explanation of Benefits (EOB) forms. EOB is a communication from an insurance company explaining what will be covered on every bill. It will note the date of service, sometimes the provider, the amount billed, what is allowed, and what the patient's responsibility will be.
- Keep a record of all communications with the insurance company, including correspondence, and names and dates of phone contact.
- Communicate with the hospital and clinic billing offices to make sure that bills are being sent to the insurance company in a timely fashion, and to make sure the insurance company is paying. Occasionally, a delayed payment from the insurance company can results in the family being billed for the entire amount.
Kate Shafer, LICSW, National Childhood Cancer Foundation