What are some tips on negotiating with my partner’s insurance company?

81. What are some tips on negotiating with
my partner’s insurance company?

One of the most helpful things you can do
is assist the patient with negotiating with
insurance coverage.

As family or a friend of a person with cancer, one of
the most helpful things you can do is assist the patient
with negotiating with insurance coverage. If the patient
wants your involvement, she may have to contact the
insurance company, her employer, and medical provider
to give written permission for you to able to give and
receive confidential information. As many of our patients
and family members tell us, dealing with the insurance
claims can be one of the most stressful aspects of managing
cancer treatment.

Contact the health insurance carrier, and if your partner
receives insurance benefits through her employer,
contact her human resources department to discuss her
policy coverage as soon as possible. Many insurance
companies have established agreements with certain
physicians and hospitals, often called the “in-network”
medical providers. Furthermore, in order to access this
“network” of medical care, a person may first need to
be referred by his or her primary care physician to see a
specialist. This type of insurance coverage is sometimes
referred to as a managed care plan. Different
types of insurance plans exist (such as HMOs, POSs,
PPOs, etc.), so be sure to contact the insurance
provider to get clarification of what is covered, and
what isn’t, under the plan.Write down the name of the
customer service agent to whom you speak.

Even with the most restrictive managed care plans,
however, it still may be possible to receive certain types
of cancer treatment out-of-network (from hospitals or
doctors who do not have specific agreements with your
insurance company), particularly if the treatment is not
available by an in-network provider. Be aware that
going out-of-network can potentially be more costly if
the patient has to pay an “out-of-pocket” share herself.

Make sure that you both are fully informed about the
coverage policy of the institution where your loved one
decides to get treatment. Some insurance carriers assign
a caseworker if a patient wants to receive treatment
out-of-network (or out-of-state), and this person can
Document all contact with the human resources
department and insurance company, and get everything
in writing, such as permission to go out-of-network or
referrals to specialists. Include date, time, name of the
person with whom you spoke, issues discussed, and resolution
or plan. Keep all of this information organized
in a filing system, and always keep copies of any materials
you send to the insurance company. If the patient
needs to dispute coverage decisions, all of this tedious
documentation will be invaluable, as it will save time
and energy in the long run.

Document all contact with the human resources department
and insurance company, and get everything in writing,
such as permission to go out-ofnetwork or referrals to
specialists.