General Practical Assistance
Insurance: Many insurance companies now have managed care plans. These can be PPOs or HMOs.
If your insurance is a PPO (Paid Provider Organization) you have a choice of doctors and facilities, but only a choice of those listed in the insurance company's network for the highest payment of insurance benefits. Usually there is a penalty for going outside of the preferred network of doctors or facilities for treatment.
If you belong to an HMO, you may only be covered if you see providers in the network; you may have no coverage at all if you receive treatment outside of the HMO network.
If you need to go outside a managed care network for treatment of a rare disease, it may be possible to get the penalties waived. Call your insurance company to find out their policy in regards to these waivers. If possible, get your local doctor(s) or health care provider(s) to write letters to the insurance company in regards to the rarity of your disease and your need to seek medical care outside of the PPO/HMO managed care network.
I believe it is in the best interest of those diagnosed with appendiceal cancer to be seen by doctors who specialize in treatment of appendiceal cancer and peritoneal surface malignancies; doctors who are surgical oncologists and who have experience with debulking surgery and peritoneal chemotherapy if that therapy is warranted.
I attribute my own survival, though, to the fact that I was seen by a doctor who had experience with appendiceal cancer and that I had the debulking surgery and peritoneal chemotherapy. In many cases you will be required to travel to see a specialist, I traveled 1500 miles round trip.
A word of advice. Carefully review your medical bills and insurance statements. If you have a friend who is a medical professional, ask them to help you. I personally saved $10,000 by doing some of the things listed below. I had to make a lot of phone calls and spent hours on hold and shuffling paperwork. I also purchased a plain paper fax machine for about $100 (it paid for itself many times over vs. a public fax), but I feel I was well paid for my effort in light of the amount of money I saved. Things to look for and to keep track of:
Deductibles: Know your insurance deductible and when you have met it. Make sure you are not overcharged.
Out-of-Pocket Expenses: Many insurance companies have a yearly limit for out-of-pocket expenses. Once you have met that limit, 100% of your medical bills may be covered, even if prior to meeting that limit you had a co-pay percentage. Check your policy and keep a running total of your out-of-pocket expenses. Also check to see if your insurance measures this time by the calendar year; it's possible you can adjust timing of treatments/surgeries/tests to get the greatest advantage from this benefit.
· Double billing:
o Check your bills and insurance statements to make sure you are not billed for something that was already paid for by your insurance.
o Also check dates to make sure you are only charged once for each service/item.
o Make sure you are not billed for an amount that should have been reduced as an in-network service. For example, your charge for a $200 office visit may be reduced to $150 because of an agreement the provider has with your insurance company. Your 25% co-pay would be 25% of the $150 dollar agreed upon reduced charge and not 25% of the $200 dollar charge in that case. It's better to pay the co-pay after bills have been submitted to insurance and you have documentation of the final accepted charge. If you have overpaid a bill, you can request a refund of the overpayment.
Life-time maximum: Check to see if your insurance company has a lifetime maximum coverage amount after which they will no longer provide any benefit. Although items are covered by insurance, it is still sometimes a good idea to price shop to avoid reaching the lifetime limit.
Denials: if coverage is denied for a service or provider, double check your policy and reasons for denial. I had some payments denied because of an error in the reporting of a claim by the provider of services. I had my provider resubmit corrected claims.
Document: Document phone calls to insurance companies and providers when disputing claims; write down names, dates and times on bills or insurance statements. It will save you time, frustration and money when you can say "On May 1 Jane Doe told me that this charge was removed from my account".
This website is for informational and educational purposes only. Readers are encouraged to confirm the information contained herein with other sources. The information on this website is not complete and not intended to replace medical advice offered by physicians or health care providers. Patients and consumers should review the information carefully with their professional health care provider.
Copyright © 2005- 2010 C. Langlie-Lesnik RN BSN All rights Reserved
Last Updated 02/09/2010 11:26:00 AM