Understanding & Dealing with Health Insurance

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Written by: Gail Borgerd

Gail Borgerd has 23 years of both personal and professional experience in dealing with health insurance companies and has spoken around the country. She is parent of a son with Fragile X Syndrome, now age 25. As a two time Bone Marrow Transplant Survivor for Acute Leukemia, she was given a five percent chance of survival prior to each transplant. Gail understands both professional and personal sides of dealing with health insurance. Today she has much to offer others facing the challenges and nightmares of insurance claims and denials.

As we get ready for the Feb. 4th, NPN Developmental Differences Resource Fair at Gordon Tech High School. We want to share some of the must-have takeaways from our three event workshops.  Here is a glimpse of what Gail Borgerd, of MedicClaim, will cover.  We hope to see you there!

Our Feb. 4th 10:30 am Workshop Topics will include:

  • How to accurately determine the level of your coverage
  • Procedures for speaking to and corresponding with carriers
  • What to do if a claim is denied
  • Dealing with Specialized Treatments and Drug Regimes
  • How persistence can pay off
  • Cobra and Other Insurance Options
  • New Illinois Laws and How they affect you (e.g., Autism Laws and Habilitative Laws)
  • How topics affect both child and adult claims

Here are some key takeaways to help you navigate and understand insurance

MedicClaim

  • Obtain a Copy of the Master Policy
  • Read your Certificate of Coverage
  • HIPAA-(Health Insurance Portability Accountability Act) July 1997. Group plans cannot pre-exist you regardless of conditions if coming from a group plan(s) with 18 months of continuous coverage, and no more than a 60 day gap in coverage. Always obtain a Certificate of Credible Coverage. Again, new Federal Laws affect pre-existing conditions.
  • Only Send Copies of a Claim and keep track of Claims by Date of Service
  • Track your Deductibles and Co-insurance Expenses and watch for errors
  • Always Log Date, Time and Person when Speaking to Insurance Company
  • Usual and Customary Fees-Never be afraid to question. Most policies now use their negotiated rates as U & C or Medicare allowed rates. Check your policy, a large percentage of claims get rejected, few people ever question them.

Always Be Polite and Courteous Yet Firm

Some Options for help-

  • State Boards of Insurance-Call for assistance. Often just a call of inquiry is enough to get insurance moving in the right direction.
  • Self-insured plans are handled differently.
  • ICHIP All Kids is an Illinois program covering children up to age 18.

Last But Not Least:  

Never Give Up!  Most times persistence will pay off. If you work for a large company, seek the assistance of the human resource director, union representative or person handling the insurance. Often they have no idea of how a company is treating their employee claims.

Important State Laws:

  • PL-094-0906: Effective 06-23-2006- Mandates 20 Additional Speech sessions annually when diagnosis is Autism.
  • Senate Bill 0934: Effective 12-30-2008- Mandates up to $36,000 of coverage for Autism and Pervasive Developmental Delay diagnosis.
  • Senate Bill 101: Effective 01-01-2010-Mandates coverage for Habilitative Services and ABA. Insurance can request reports for therapies, proof of improvement and not just maintenance for therapies. This bill excludes self -insured plans with the exception of state, county and municipality plans.

For more information, please join us at the Feb. 4th Resources Fair and come to this 10:30 am workshow or contact MedicClaim Consultants, LLC Ph: 847-657-1157 or email: Help@MedicClaim.com.  "Let Us Make Your Life Easier"

Posted on January 14, 2012 at 8:59 PM

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