02/15/2019
10 Tips for Navigating Health Insurance and Medical Bills in Breast Care
1. Know your insurance policy.
• Get a copy of your policy and read it. Know what is covered and what is not.
• Find out what is considered preventative care. What will your expenses be to go out of network? All these details will help you be a more informed health care consumer.
2. If you have insurance, know which physicians are in your plan.
• Do you need a primary care provider?
• Do you need a referral from your primary care provider to see a specialist?
• Do you need to see providers that are in network?
• Will exceptions be made if there are no specialists within your plan?
3. If you do need a referral, ask for a copy of the referral letter for your records in case there is a denial of coverage.
4. Keep a record of your breast imaging and laboratory tests.
• Your specialist may want to order tests. If you can show that you have already had the test(s) you can avoid duplication.
• Ask for your images to be placed on a disc so that you can have these available for your specialist’s office visit.
5. Ask for itemized copies of hospital bills.
• Make sure there are no duplication of charges.
• Make sure that there are no erroneous charges or procedures.
• Make sure that the correct diagnosis codes have been assigned.
6. If you do not have insurance, ask to talk with the hospital or medical center before your planned testing or surgery
• Often arrangements can be made beforehand to manage charges.
• Negotiate a deal.
• See if the hospital has any programs to assist uninsured or underinsured patients.
7. Ask your surgeon, or nurse navigator if they know of any assistance programs.
• Some states have programs to assist women in covering screening for breast and cervical cancer.
• Regional non-profit organizations can provide assistance to cancer patients.
8. If you face a denial and need correspondence, send by certified mail.
• Having a paper trail is helpful in documenting that information was received.
9. If you work for a company with a Human Resources Department, recruit their help.
• Many a cancer surgery that was held up awaiting an insurance company’s pre-authorization was magically approved within minutes after a call from a large company’s Human Resources Department. The insurance companies do not want to risk losing the contracts of large companies.
10. Ask your doctor and pharmacist about your medication.
• Find out if there is a generic version of the medication.
• See if the medication is covered by your insurance plan.
• Ask if there are other medications that may be substituted if the medication that your doctor prescribes is too expensive for you.Sometimes the cost of the medication in cash is less than the co-pay of the medication on an insurance plan and it is cheaper to pay cash.
