How to Get Help from a Medical “Insider”

November 2011
Bottom Line Health
Charles B. Inlander

Anyone who is diagnosed with a serious medical condition knows how overwhelming it is to deal with insurance problems, schedule the tests and get answers to all the medical questions that inevitably come up. Dealing with these “logistics” can even take more time—and certainly more of your energy—than the treatment itself. Fortunately, there are now many knowledgeable health-care specialists who can lighten your burden by assisting with these issues. Bonus: (The cost of such services is usually covered by your health insurer or the doctor or hospital you use. Medical “insiders” you should know about…

Nurse navigators.These skilled registered nurses (RNs) or nurse practitioners (RNs with advanced training) are usually employed by hospitals (especially those providing cancer treatment) or specialty medical practices. They help patients receiving inpatient or outpatient care with all aspects of their treatment. For example, when my mother-in-law needed radiation after breast cancer surgery, the nurse navigator at the hospital cancer center helped set up her schedule, cleared everything with Medicare and her supplemental insurer and met with her at least twice a week to answer any questions she had about her care.

Medical social workers. Most hospitals have staff social workers who help patients cope with medical concerns and deal with issues such as aftercare follow-up. Among their many other services, they help arrange for transfers to nursing homes, intervene with insurance companies if there is a coverage dispute and set up hospice services for patients who are approaching the ends of their lives. Many medical practices also have social workers on staff to help manage patient issues. For example, several years ago, my insurer wrongly denied a payment to the hospital after I had undergone prostate surgery, making me liable for a $9,000 charge. The insurer claimed that the second day of my stay had not been approved. I called my urology practice’s social worker, who got the approval number that the insurer had given the hospital at the time of my surgery, and the charge was immediately dropped.

Your insurance company. I know, I’ve been saying that insurance companies are part of the problem! But in recent years, most larger insurance companies have put together teams of personnel—often nurses, social workers and even doctors—whose primary role is to provide customer assistance and guidance on issues well beyond those related to insurance. For example, insurers such as United Healthcare and Blue Cross can help you find home-care assistance or alert you to free or low-cost programs such as elder day care. Medicare also offers similar services. Call 800-MEDICARE (633-4227).

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Remember: Someone who works within the system, as do these health-care insiders, can be a great ally in helping you get through difficult medical problems.