When It Comes To Health Insurance, Knowledge Is Power

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By Mary Brolley, Staff Writer

health insuranceExcerpted from Network Newsletter Spring 2010

Ricki Hasou has seen the health insurance game from both sides. After a long career with a major insurance company, she joined M. D. Anderson in 2007 as a senior managed care analyst in the Department of Managed Care.

Since then, she's helped M. D. Anderson patients figure out how to deal with their managed care plans.

For cancer patients who have insurance coverage, keeping up with the paperwork from their insurance carriers and health care providers is daunting.

Organization, record keeping essential

As many patients have discovered when they're dealing with an onslaught of mailings and e-mails from providers -- especially during a long or protracted illness -- it's nearly impossible to remember whom you called, what you discussed and exactly when.

Yet, because these details may help build or support a case, it's crucial to track them in a notebook or maintain notes in a file.

Knowing your policy means reading the materials sent or provided when you enrolled. Take your time, read through it, figure out what type of coverage you have.

Define the terms
Many patients consider traveling to Houston to be treated at M. D. Anderson, so in- and out-of-network benefits are one of the largest areas of concern. Every day, Hasou's colleagues in Managed Care and in the Department of Patient Access Services go to bat for those who want to be treated at M. D. Anderson. Physicians and their staffs are also accustomed to stepping in to help assure coverage.

Your insurance card yields insights
Though this may seem simple, your insurance card provides a good deal of information and is essential to getting anywhere.

The card contains identifying information about the cardholder and the policy, including co-payment amounts.

Customer service personnel: your allies
Hasou insists that the staff of the insurance company's customer service department is or should be the patient's or caregiver's friend. "The person who answers the phone is your advocate," she says. "He or she is there to help you."

Hasou's advice? Take a deep breath. You'll likely have plenty of time to do so while you're on hold. Then, she advises, be polite but persistent.

Read the Full Article in Network, Spring 2010

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