As a therapist, who billed insurance, for over 10 years in Private Practice, and now in the present as a Professional Organizer, Life Coach in Orange County, California, the biggest question mark for people always is wondering what healthcare coverage actually covered. The second biggest Huh? is whether you will be fairly reimbursed. The third dilemma about healthcare coverage is how difficult it is to understand the benefits, the parameters and the small print. And last but not least is the cost of the program itself, the co-pays, and deductibles.
Health Insurance is all so confusing and a real maze even for the best minds and the brightest people.
Here are some of the ideas and thoughts I have about health care and wellness.
I was not on insurance panels after my first couple of years in Private Practice, but I would and could bill into the" out of network" portion of someone's plan. I billed all the biggest plans, Aetna, Cigna, Blue Cross, Blue Shield, PacifiCare, Medicare etc... The first thing I would say to a client is "Do you have Mental Health coverage?" I would always be met with that "Doe in the Headlights" stare and a quick "I'm not sure". I honored my clients, as a practitioner, to look up the benefits for the them, and it was my ethical duty to help them understand their coverage. It made life easier for everyone knowing what was to be paid and what the client would be responsible for. Many doctors today don't care if you get reimbursed, but rather that they are paid in full.
Many therapists and health practitioners don't care either if the client's insurance will cover their services, since they make the client pay up front. Most practitioners don't care if the client gets reimbursed, and they rarely advocate for their reimbursements. I thought that was wrong and stupid on the part of the practitioner. I found that when everyone was clear, on the cost and the benefits, the treatment went much smoother and the alliance to treatment much stronger. If a client did not have coverage I offered a sliding scale fee with proof of hardship, so they wouldn't have to pay my full billing fees. Many doctors will do that if asked. It can't hurt to ask if a Physician or therapist will extend a helping hand.
When you go to the doctor today the prices of services are
like mystery meat, you never know what you are getting yourself into and it
could be a big disgusting mess for you financially. You can ask how much for
this and how much for that and you may never get an answer until the bill comes
in the mail or you’re checking out (no pun intended). This can make life full of
stress and eventually you may avoid going for health care treatment just to
avoid the unknown cost.
THIS IS A BIG MISTAKE!
"The most important thing we have in life is our health, and without health there is
nothing else!" This is a great quote from my grandmother who lived until 88 with
heart disease, a stroke, arthritis and high blood pressure. Why did she have a
great quality of life until the end? She loved going to the doctor's office.
Why did my grandmother love going to the doctor's office? Because her
daughters, my two aunts, drove her there and figured everything out for her.
My aunts both highly educated school teachers could read the fine print, find physicians on her panel, negotiate with the practitioners and call the insurance companies when reimbursements didn't show up. So bottom line is you have to be your own advocate and it is time consuming. If you don't have time to advocate for
yourself find an advocate or have someone you know, who has free time, to help you
get the answers you want to make a good decision about who treats your health.
There are doctors out there now who will look up your benefits, but as
soon as they get on the "hot tamale train" and are "popular" they start
accepting private pay only or they want payment up front prior to billing.
It is understandable that they don't take the time to help you; in many cases doctor's
reimbursement fees have hit an all-time low. They can barely keep afloat. Most
physician/practitioner reimbursements are dictated by Medicare and those rates
just keep on going "down town Julie Brown".
Another hurdle in understanding your insurance plan coverage is not just to read the fine print but to understand it all. I don't know about you, but I can't read small print anymore even with a magnifying glass, so I usually call the 800 customer service numbers to talk to a representative. If I can understand the foreign dialect then I usually get a good solid answer, but oddly enough many customer services are now in the Philippines and India. I don't know about you, but it is difficult for even an interpreter to understand the dialects. I also find with customer service agents that their true knowledge of your plan is not necessarily succinct with your actual plan. I have asked 4-5 customer service people in one day the same question and come up with 4-5 different explanations. I then realize I must go higher for higher knowledge of the plan,
One of my secrets for understanding the insurance plan's worldwide customer service people is that if I cannot understand them, and or their dialect, I call the corporate office and talk to the assistant to the CEO, or the closet person I can find to the CEO. They will be surprised that you are calling them, but you have every right to have a representative that you can understand, and that will break down the services and the coverage for you in a clear and concise manner. If you have trouble locating the CEO's office, look up the plans investor relation's email and write them a note about your troubles, and someone will get back to you, and or look up their annual report and find their corporate number.
I love people from all over the planet, but some I just really cannot understand even if I strain. They are either slurring, talking to softly, the dialect is thick and or they do not speak english well, and I don't speak their language at all. Sometimes I realize that the customer service folks are naturally not happy with their job, and or have been trained to be passive aggressive, repeating my questions without giving a clear answer in a ping pong communication style. I end up asking the question in 14 different ways, and all I end up with is an answer that does not pertain to my question. I call this communication style a circular discussion. I start out polite with customer service folks, on most occasions, and when my blood starts to churn I just explain that I cannot understand and that I have to move on. Other times I realize I don't have the correct question and lingo to find out the answers, and with any added language/communication barrier I don't get too far. When this happens do not be afraid to take it to corporate. DON'T GIVE UP. Your health care is too important. You are too important. Your family member is too important. Going to the doctor regularly is an emotionally intelligent thing to do!!!
Always remember the person that wrote the insurance policies make it tricky for a reason and that whoever wrote the policy is probably NOT smarter then YOU!
Marla Stone, Health Wellness
Marla earned her BA in Psychology and a Master's in Social Work and is the founder of I-Deal-Lifestyle, a Self and Space Organization Service.