Create a Health Notebook as Part of your Over 50 Plan

Does your health insurance coverage revv up your stress level?

Beware: it will likely be coded as a pre-existing condition and you’ll be stuck paying all associated expenses related to the situation.

Healthcare coverage is constantly making news and is a hot topic for government and politicians. As they battle out what to do, we’re left with the results which often hit us hardest.

Regardless of whether you are self-employed, employed by a corporation, or retired, a new situation you’re likely to encounter soon (if you haven’t already), is your health insurance company will decline all services, leaving you to dispute your claim. Furthermore, according to several news sources, this is a growing trend and there is nothing we can do.

Well, I’m not one to give up that easily!

Since 2017, every scenario I visited a healthcare provider for was denied whether this was well-care, illness, or injury. Here are a few examples:

• November 27, 2017, I visited the urgent care following 3 weeks of a persistent cough. Fortunately, the cough was “just a cough” and a few weeks later, the claim was dismissed as a pre-existing condition. The insurance company requested 5 years of medical records for their specialists to review if I chose to dispute. The process took 17 months mostly because the insurance company denied receiving anything from my healthcare providers. The bill was eventually covered according to the policy.
• I became sick with the flu in January 2019; the insurance denied all coverage, calling it a pre-existing condition. Current status: in review.
• Another incident, dated February 2019, regarding my dental insurance, resulted in the insurance company claiming the situation was 1: out of network and 2: cosmetic (a ceramic crown vs a metal crown on a back tooth). Although the dentist explained the full-metal crown is an outdated procedure, the insurance refuses coverage. Current status: in review.

Just as I was thinking this was the curse of self-employment, my daughter (who is employed by a local hospital) calls with a similar situation: a visit to her doctor resulted in an out of network claim plus the annoyingly familiar pre-existing condition claim. She is now in the battle for proof.

In essence, we’re all screwed when it comes to healthcare coverage. The only way to help yourself is with METICULOUS record-keeping! Following my 17-month battle with my health insurance company, I developed a process to ease the pain. Regardless of what the health situation is, you must create your own healthcare record book. Here’s what that looks like:

Get yourself a notebook. A 3-ring binder with pockets for all your health information will be best.

Start with symptoms. Regardless of what the situation is, and whether or not it is new or pre-existing, write down your symptoms. From allergies to injuries, the more detail you provide yourself, the better. This includes the date and time of when first noticed!

Healthcare visits. Once you decide to visit a doctor, make notes of who did you see? When? Where—ER vs Urgent Care vs specialist vs primary care physician? How long were you there? Who did you speak with? Note: Many bills break your visit down to 15-minute increments with a physician, a physician’s assistant, techs, and more. Keep track of the time.

What were the results? Gather copies of ALL information! Were tests ordered? Ask by whom? Get a copy of the order. Important: before tests are ordered ensure the referral facility is in-network. If not, ask for one within your network. Don’t leave the medical office without the answers. Note: Sometimes the medical/billing staff will not know if the referral facility is in network. If so, you must call your health insurance company to get the most accurate answer.

Gathering intel. Once the phone calls begin, it is vital that you document who you spoke with, the date, time, and any other useful information discussed during the call. This includes the call number and phone tree digits (ex. press 1 for customer service, press 2 for billing, etc).

Gather names, ID and account numbers, and phone numbers. The more you have in advance, the easier it is to get right to the person of interest.

Preventive care or aftercare? Do you regularly schedule preventive care visits? Make sure medical billing is clear on the purpose of your visit and it is coded correctly. Ask how will this be coded and what the codes mean (I’ve had to resubmit claims because codes were wrong).

Record gathering. Get 2 to 3 copies related to each visit and if your health insurance company requests records; one for you, one for the insurance company, and a spare. Send the records certified mail, otherwise it will be too easy for the health insurance company to claim they never received them.

Get addresses. If records are requested, obtain the correct address of where you must send them. If you can obtain a name, get it! (I have had to do this after my insurance company claimed more than once they never received the demanded records—for the cough.)

Back up. Once a visit or procedure has occurred, keep all information together in a hard file and a digital file. If you don’t have a scanning/copying machine now, you may wish to get one soon. It will be a big help with the record-keeping process.

Follow up. If there is a dispute, ask the person you speak with when they expect results. They’re typical answer is, “Two to three weeks,” to which your answer will be, “Great, I will call on such-and-such a date.” AND DO IT!

Before any visit. Before any planned visit, call your insurance company to ensure the situation will be covered. Inform the company which facility you plan to visit to ensure they are in-network. If the visit is an emergency, this is tough to do, however, a quarterly review of your coverage will keep you prepared. Once again, document everything! Note: check in yearly with your healthcare providers and your insurance company to assure that everyone continues to “play nice together.” (After my hospital merged with another, I later found out that my hospital was no longer in network.)

Keep track of premiums, payments, and deductibles. How are you making payments? Did you pay in full? Make sure you get proof of payment from all providers. Keep your checkbook and budget up to date in case a provider or health insurance company surprises you with a PAST DUE bill.

Keep all records! To prove a condition is not pre-existing, the insurance company demands 5 years of medical records from all healthcare providers. So keep those records at least 5 years. My advice is to keep them forever because no one knows you better than you do and, when it comes to your health, you’ll have a detailed history of your health.

I’m told by my health insurance broker I have good insurance. It’s hard to say if I do or not considering the headaches I must go through for coverage. Regardless of what I see a healthcare provider for, I must battle every visit for proof of need and coverage. It’s a hassle but it’s a necessity. Your record keeping will help you sleep better at night.

To your health!

Kristen Edens

photo credit: Alexander Dummer of pexels.com