Health Champion Blog

And you Know What You Don’t Know!  That’s the important — and tricky — part.

“I have a Harvard MBA and I can’t figure this stuff out!”

That was the frustrated cry from a prospective client during an initial consultation. She came in, plopped a stack of papers on the conference room table, took a deep breath and blew out her embarrassment with those few telling words.

We weren’t surprised. But we were compassionate and reassuring. There’s no reason to be embarrassed. Frustrated? Yes. Overwhelmed? Yes. But not embarrassed.

Navigating the world of clinical decisions, medical bills, claims, and benefit explanations is a daunting task. Having an advanced degree doesn’t necessarily simplify matters. In fact, the majority of our clients are well educated and successful in their chosen fields. But it doesn’t mean they have the time, energy or inside knowledge to tackle the health care system.

Back to our client. During a medical crisis, she lost control of the edges. The mound of paperwork was staggering: she didn’t know what had been paid, what should have been paid and what needed to be submitted to her insurance company for reimbursement. We untangled the bills for her and helped establish a system for future use.

Here are some tips for staying organized:

• Register as a member on your health plan’s website. Use their tracking tools to see what claims have been received, paid, and in what amount.Be particularly diligent when seeing out-of-plan doctors, even if you have coverage. Expect to pay the provider and submit a receipt for reimbursement.
• Watch for claim filing limits (the amount of time you have to submit the receipt to your health plan). This information can usually be found in your member handbook or plan documents in the section on claims submissions or filing.
• Keep a copy of your benefits summary handy so you can compare out-of-pocket responsibilities against the benefit summary from your health plan.

The key to success is knowing what you know and seeking expert advice for the rest.