Insurance Advocate: Why and when to get one
April 10, 2012 in Day to Day Life, Everyday with Special Needs
Medical Insurance is a serious issue for many of us. Fortunately many insurance companies are allowing special needs adults to remain on their parent’s insurance policy indefinitely. Many of our adults still have serious medical issues. Who knows what the medical future will be for them. Suffice it to say that we parents will be dealing with medical providers and insurance companies on behalf of our adults for most of our lives.
A few weeks ago another special needs Mom and I were visiting over basketball practice. She was telling me about the horrible bills they incur for their special needs adult who requires regular shots. We were lamenting how difficult it was going to be for our adults to ever support themselves when their meds are equal to their SSI. I remembered a blog post I had read earlier about free advocates provided by our own insurance companies. I have to share it with you.
Gina St. Aubin at http://www.5minutesforspecialneeds.com/12255/insurance-advocate-why-need-one-how-get-one/comment-page-1/#comment-347180 describes her experience with her insurance company advocate while they were receiving treatments for her special needs child. I was flabbergasted that such services existed. This is something every family with medical issues should know.
With Gina’s permission, I’m sharing it with you:
Insurance Advocate: Why You Need One and How To Get One
Remember that list of caseworkers I told you about? Well, in my haste to count on all my fingers the number of caseworkers in our life, I neglected one very, VERY important caseworker / liaison we’ll call “Miss W, The Insurance Gal”.
I could tell you a lot about “Miss W, The Insurance Gal”; give a number of examples of how this woman has made our life easier, insurance more accessible, has caught mistakes, gained us two more IVIG treatments (yes you heard me, two more) that she said was ‘owed’ to us. I could tell you about how she singlehandedly has the Children’s Hospital working for HER (thus for us) to get more approved…I can tell you just how much I want to squeeze this woman with shoulders a little less weighted…but instead, I want to encourage you should get one.
One what? Well, she is a patient liaison. I believe in our insurance company, she is called “My Personal Champion”. Other companies may call them coordinators, liaisons or case managers. The great advantage of having access to a person like this is that they almost work as a middle man between you and the insurance company by understanding and advocating for your needs, and using their company knowledge to help you gain the best use of your insurance.
How to get one:
- Contact your insurance company. Ask if there is a program that helps you navigate insurance when there are significant potential, ongoing and/or consistent medical issues that will require skilled attention
- If you’re unable to reach such a person / department, do not hesitate to contact the Human Resources or Employee Relations department of the cardholder’s employer (for me, I contacted my husbands ER department). They should be able to definitively tell you if the insurance company has one (I’d be disappointed if all insurance companies don’t). If needed, take a moment to explain to the HR/ER department your situation (synopsis) if they don’t already know. You might express the need to have another individual available that you can ask detailed and intricate questions that the average call center person would not be able to answer. Further, that a single contact knowledgeable of your specific ‘case’ would be helpful
- Should your HR/ER person give you the name / number of such a department, follow through and call. A lot.
- If this doesn’t work, call the HR/ER person again and ask them to call.
- When you receive this case manager, should they ask you if you want to be with them long term, the answer is yes.
Now, I asked our present insurance company at least 3 separate times, on at least 3 purposeful phone calls about such a department. They confirmed its existence, yet denied me access, feeling we didn’t ‘qualify’ for one. Even explaining that we’re quickly working our way towards brain surgery on a child didn’t get them to budge. I did exactly the above and contact the ER department (who already knew our situation), explained just how far things were going, explaining we needed more questions answered, were coming up against tougher scenarios and that we NEED help. She called the insurance company and they contacted me within 48 hours. Seriously. And she’s been invaluable.
So please, if you don’t have one, if you face long term or significant medical bills, therapies or surgeries, do your best advocating in this area. You will be glad you did.
Still, I’m curious. Most people I talk to didn’t know programs like this existed. Did you? Have you had experience with your own version of “Miss W, The Insurance Gal”?
To find out more about Gina see http://specialhappens.com/about/contributors/
Medi-Cal may or may not provide advocates. We don’t use Medi-Cal. Patrick’s Dad has the same insurance he’s had since before Patrick was born. I can’t call to ask for one from them, but if any of you do use Medical and find out, please let me know.