We are sharing the wisdom of our late founder Gary Barg with columns that he wrote over the years.
Gary Barg, Editor-in-Chief
As family caregivers, you are the center of the healthcare universe for your loved one. Although the great majority of professionals work very hard and care very much, it is you whose role it is to make sure that the healthcare system gives the best if has to offer to your loved one.
You need to understand that many of your loved ones, especially if they do not live with you, will see a variety of doctors all of whom could unintentionally prescribe conflicting medications.
- When was the last time you looked into your loved ones medicine cabinet?
- Have you ever scooped up all of the prescription bottles into a paper bag and carried it to their pharmacist to ensure that all medications work well together?
- How about listing all of the prescriptions and any over the counter medications on a sheet of paper and sending it to your loved ones primary care physician for review?
These are things that only you can do and these are things you should do.
As a caregiver you also need to be adept at dealing with insurance issues. Especially in today’s complicated world of HMO’s, PPO’s and long term care policies. What happens if your insurer refuses to pay part, or all, of your bills? It is not that uncommon.
What many people don’t realize is that they can appeal if their insurer says no. And people who know their rights have an outstanding chance of winning those appeals.
The following are a few suggestions for arming yourself should the need to appeal a refusal of insurance payment arise.
Save everything! Don’t discard any insurance papers or any papers pertaining to your treatment. Save receipts for all doctor’s visits and all prescriptions. Save copies of referrals to specialists. When you are speaking with any employee at the insurance company, write down their full names, positions, extensions, and whatever they tell you to do. Keeping all of these things in a portfolio in some kind of order can only help you organize.
Make sure your appeal is airtight. Writing a letter defining your position is your first step. A letter is documentation – a phone call is not. Your letter should be detailed, yet concise. Include important information like your claim number, group number and policy number. State the reason for coverage denial, then describe your illness and treatment. Next, state why you believe that your insurers made the wrong decision and then offer a solution. Close by saying what you would like your insurers to do. Your primary care physician and any specialists involved should write letters as well (provided they are on your side).
So don’t take it lying down. You have certain rights as an insurance consumer. A very small percentage of people ever appeal under these circumstances, but it should happen more. It is probably easier for the insurance company just to pay the claim rather than fight someone who knows how to stand up for their loved ones rights.
Now go out and have a truly restful Labor Day weekend.
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