Dealing with Insurance Companies

Dealing with Insurance Companies
Lisa Knigge Rondeau, Project Leader

Having a child in the NICU brings with it so many emotions and realities, and often times one of the most stressful ones has to do with medical insurance. It won’t be long before the bills and phone calls start pouring in, and this is of course the last thing any new parent has time or energy to deal with. But sooner or later you will have to deal with it, and it’s better to be prepared when that time comes. Here are some tips that might be helpful for you as you begin that bureaucratic journey:

• The number one thing to do right away is to find your copy of your health benefits book from your insurance company and start reading it over. You most likely would have gotten this when you first enrolled in your insurance plan, and sometimes a new one is given each year with any updates and changes. Find it and start looking at the specific sections dealing with hospitalization charges, specialists, and in network versus out of network charges. You will also most likely have a short window to contact your insurance provider or employer to add your new baby as a dependent. This must be done to be sure they have coverage under your plan.
  
  
• Contact someone in the hospital’s billing department. Usually, they know right away, or can find out fairly quickly, if they accept your insurance and what your estimated co-pays or out of pocket costs might be for the first couple of days. Sometimes the NICU social worker also helps in this area—be sure to ask.
  
  
• Start a folder right away labeled with your child’s name and birth date, and keep ALL receipts, notes, forms, and bills in this same folder. This keeps everything together in one place. As a new parent and a NICU parent, your stress level will be high. Don’t add to it be misplacing important papers or forms. If everyone—you, your spouse or partner, parents or anyone else helping you—knows that all forms go in the folder—it will save lots of headaches down the road.
  
  
• Keep detailed notes. Whenever you talk to someone about a bill or statement, write down a quick summary of what was discussed. You can do this right on the bill if there is room, or attach another sheet of paper if that works better. Do not make the mistake that I often did and think that you will remember what was talked about because it was so important—chances are, you won’t. You’ve got enough on your mind. You don’t have to write a lot—but do include the name of the person you talked to, the date and time of your call, and a brief summary of what was discussed. This will be so helpful if later on you have to talk to someone else about the same issue.
  
  
• Once the bills start really coming in—don’t stress yourself out by looking them over every day. Just open them, put them in your folder, and designate one day a week to look over them. Nothing is going to change in a week’s time, and by setting aside that specific time each week, you spare yourself a lot of worry and anxiety over each day’s mail.
  
  
• If you are having trouble paying the bills or not getting what you need, see if your hospital of insurance provider has a medical billing advocate that you can talk to. Medical billing advocates are sort of like a middleman between you and the hospital to help everyone come to a resolution regarding bills and payments. While they are not found everywhere, you should definitely look to see if one is available in your area.
  
  
• Know your insurance company’s appeal process. Sometimes this information is printed right on the bottom or back of bills, if not; check your health benefits book again. If you think a charge is denied and it shouldn’t be, you will have to file an appeal. Often time these are a lot of work—but it is necessary if you think something isn’t being paid that should be. You may also need to get detailed medical records on certain conditions or letters from healthcare professionals like doctors—don’t be shy about asking for these. In this day and age, doctors are well aware of the difficulties found in some insurance policies and most likely will work with you to try and get it resolved.
  
  
• Lastly, find out if you qualify for any state or federal programs. Often, the NICU social worker or discharge planner will handle this. Each state has different criteria and regulations, but you should check to see if your child is eligible for Social Security Income, Medicaid/Medicare, WIC, or any other programs.
  

Hang in there. No one likes dealing with paperwork and forms. If this is a task that can be delegated, perhaps to a spouse, do so. Insurance paperwork is time-consuming and draining, but it is usually short lived.