Spare Yourself Grief: Get It In Writing

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Spare Yourself Grief: Get It In Writing

As the director of AdvoConnection and its associated websites, I hear about so many patient and caregiver complaints, problems, hurdles and – dare I say it – atrocities. Among the most frustrating and egregious I hear way too often;  that is, with advance permission from their insurer, someone underwent a test, a procedure, or surgery, or saw a specialist, only to be told later that the insurer wouldn’t pay for it after all. Wh-a-a-a-t??  If this has happened to you, you are probably vigorously nodding your head. It happens all the time!  If you have not yet had the experience, then your eyes may be wide open in horror!  And I’m here to tell you the same thing could happen to you. So let’s see how we can prevent that! It’s actually not too difficult, but might be more or less so depending on what the permission needs to be, and how soon you need to get it.  The first thing to know is that there is very little black or white with insurance companies. Sometimes getting permission is just a matter of the day of the week, the time of day, or even the customer service rep you talk to. (BTW – as an aside – insurance customer service reps sometimes call themselves “patient advocates”  Really? Who are they advocating for?  Themselves, of course!  Not you! So don’t be fooled.) Not that your insurance plan doesn’t have parameters – it absolutely does. But there are so many gray areas, that one person might interpret coverage one way, and someone else might interpret it another. So the key here is that you are seeking a promise of coverage ahead of time, before you undergo, or purchase, or visit something related to care.  To do that, you call your insurer to get that promise. Ideally all this will take place weeks before your medical care takes place. You may need that much time. Even if you don’t have that much time, take care of this as early as possible, because this work on the front end will possibly save you a great deal of grief – and money – afterwards. Begin by asking your provider what the “CPT” and “DRG” Codes are for whatever you are seeking coverage for. A DRG (Diagnostic Related Group) is a code for your diagnosis. A CPT (Current Procedural Terminology) is the code that describes exactly…



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