How to Find An Insurance Advocate to Champion Your Cause

Once a list was made…long, long ago. A list unlike that which most people make. A list of caseworkers. Caseworkers, therapists, social workers, physicians, educators, administrators and others who had a “stake” in our quest to keep moving forward in our son’s care and development. It was quite the list. One of the most important people on this list, at that time in our lives, was someone you wouldn’t expect.

We called her “Miss W, The Insurance Gal”. I could tell you a lot about “Miss W, The Insurance Gal”: give a number of examples of how this woman made our life easier, made insurance more accessible, caught mistakes, gained us two additional medical treatments that she said was ‘owed’ to us. I could tell you about how she singlehandedly had the hospital working for HER (thus for us) to get more treatments approved.

I can tell you just how much I want to squeeze this woman with shoulders a little less weighted…but instead, I want to encourage you to get one. She was “My Personal Champion” (as our medical insurance titled her) aka, a Patient Liaison who was assigned to us through our insurance company.

Other companies may call them coordinators, liaisons, advocates, concierges, advisors or case managers. This person is different than a patient financial liaison who helps you manage the financial aspects alone. This person helps navigate things such as authorizations, tracking where bills are in the process of payment, get you through the appeals process, find ways to get certain treatments covered, etc. The great advantage of having access to a person like this is that she or he serves as a go-between between you and the insurance company, by understanding and advocating for your needs while using their company knowledge to help you gain the best use of your insurance.

How To Get A Patient Advocate

Contact your insurance company: Ask if there is a program that helps you navigate insurance when there are significant potential, ongoing and/or consistent medical issues that will require skilled attention.

To help you a little further here’s a list of a few of the top insurance companies and the phone numbers to their specific departments that should be able to get you started with a patient advocate:

Blue Cross Blue Shield / Blue Care Network:

a) 1-855-425-8585. You can also find additional information here.

Kaiser Permanente:

a) Complex Care Management – usually via a referral from a hospital, nurse, physician or the like. You can also request a referral to their program at 303-614-1065. You can also find additional information here.

Humana:

a) Care Manager for Medicaid Patients – 1-800-432-4803. You can also find additional information here.

b) Case Management / Chronic Care – can be accessed via a completed physician referral form (here) that is faxed to 1-877-770-0651. You can also find additional information here.

Aetna:

a) Specialty Care Management – based on a specific diagnosis. 1-866-237-3320. This department can help you connect with Case Management. You can also find more information here.

Cigna:

a) Case Management is available for those with complex medical conditions. You can also complete the form (here) and fax it to 1-866-730-1556. You can also find more information here.

Anthem:

a) Case Management / Chronic Conditions – requires a general referral to their program from a physician. 1-866-797-9884. You can also find more information here.

United HealthCare:

a) Care Management – it divides this up depending upon the reason for the need for assistance. 1-866-463-5337. You can also find more information here.

Human Resources: If you’re unable to reach such a person/department, do not hesitate to contact the Human Resources or Employee Relations Department of the primary cardholder’s employer (for me, I contacted my husband’s ER department). Those departments should be able to definitively tell you if the insurance company has one (I’d be disappointed if all insurance companies don’t).

If needed, take a moment to explain to the HR/ER department your situation (synopsis) if it isn’t already aware. You might express the need to have another individual available to whom you can ask detailed and intricate questions that the average call center person would not be able to answer. And ask that a single contact knowledgeable of your specific ‘case’ would be helpful.

Follow Through: Should your HR/ER person give you the name/number of such a department, follow through and call. A lot.

Be Persistent: If this doesn’t work, call the HR/ER people again and ask them to call.

Finally…When you receive this case manager, should they ask you if you want to be with them long term, the answer is yes.

When our insurance company changed, I asked at least 3 separate times, on at least 3 purposeful phone calls about such a department. The company confirmed its existence, yet denied me access, saying we didn’t ‘qualify’ for one. Even explaining that we’re quickly working our way toward brain surgery on a child at that time didn’t get their staff to budge.

I went through the exact steps indicated above, contact the Employee Relations Department (who already knew our situation), explained just how far things were going, that we needed more questions answered, were coming up against tougher scenarios and that we needed help. The department called the insurance company which then contacted me within 48 hours. In the end, if you face long term or significant medical bills, ongoing therapies or surgeries, it would be in your and your loved ones’ best interest to take the time to find the best advocate in this area. You will be glad you did.

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