How do I get fast answers from my insurance company?

I always tell my customers to CALL ME with any questions about their health insurance coverage. As an insurance professional, I work with insurance companies every day so I know who to contact regardless of how complicated an issue may be. It is my job as their agent to take care of these matters for them.

If you don’t have an agent you can rely on for answers, here are a few tips to make the process of calling your insurance company a little bit easier:

1.    Have all pertinent information handy, including your insurance card, your Medicare card (if you have original Medicare), billing statements from your hospital and/or doctor and your Summary of Benefits. If you are discussing a specific procedure, ask your physician for the diagnostic code he or she uses.

2.    Familiarize yourself with the basics of your plan including your co-pays, cost of visits to specialists, out-of-pocket maximum and annual deductible.

3.    Be prepared to take notes. Write down the date of your call, the name of the person you spoke with and what they told you. Ask if they can send their response via e-mail so that you can save a copy for your records. Many issues will require more than one phone call, so keeping records will prove helpful should you need to check back.

4.    If the insurance company representative promises to get back to you by a certain date, note this on your calendar and be prepared to follow up then.

5.    If the insurance company agrees to make an exception to their coverage rules, get that agreement in writing. The alternative is to record your conversation.

6.    If you are calling on a parent’s behalf, be ready to put Mom on the line to let the insurance company know it’s okay to talk with you. If possible, set up a conference call including your parent on the call. If you will be handling your parent’s insurance matters often, find out what forms are required in order for you to represent them.

7.    If you’re discussing complicated medical issues, ask to speak to a nurse. Many case managers at insurance companies are RNs who can be more familiar with medical issues.

If you take these steps, I think you’ll find the process of getting answers from your insurance company a lot less frustrating. And, if you prefer to have someone do the leg work for you as I do every day for my customers, give me a call to learn how you can become one of my customers.

Beware of Sales Pitches during Open Enrollment

Before you make any changes, please read this:

If you’re over age 65, your mailbox is probably being swamped right now with a variety of Medicare Advantage Plan offers. Here are a few tips to keep in mind if you decide to do some shopping around:

Tip 1:  Double check any mail that promises to give you details on Medicare changes for 2015 to make sure it is sent from Medicare and not a sales pitch from an insurance company. Mailings have been spotted that look like the real deal, but are only meant to generate leads for insurance companies.

Tip 2:  Ask for details. Know what coverage your current plan provides and do a side-by-side comparison on co-insurance, co-pays, premiums, prescription costs, deductibles, doctors and hospitals in the provider network, etc.

Tip 3:  Be careful sharing your personal information with anyone you do not know or with whom you do not have an established relationship. Scammers are always looking for an opportunity to tap into your personal information.

Tip 4: If I'm your agent, call me before you make any changes.

I want to continue to provide you with all the personalized services you have come to expect from me. But, if you make changes in your Medicare Advantage Plan or other insurance through an 800 phone number or someone sitting at a table at your local pharmacy, you will lose me as your agent of record. That’s just the way the insurance companies 

I want to continue to be here for you when you need me. Please contact me and only me when you have a question or concern about your insurance.

What's the difference between a Medicare Advantage HMO and a PPO

Which one is right for me?

The abbreviations used to describe the different types of Medicare Advantage Plans can be confusing.  Here’s a breakdown of the main categories you’ll come across.

Let’s begin with HMO, short for Health Maintenance Organization. Generally, HMO’s tend to be among the more affordable choices because they usually have zero or low premiums (the amount you pay an insurance company each month for coverage) and low deductible (the amount you have to pay first before your plan starts to foot the bill.)

Except for emergencies, HMO’s do not cover care received outside their network. If you have a doctor that you want to keep seeing, it’s important to make sure that doctor is “in-network” for any HMO you’re considering. You may also have to choose a primary care physician (PCP) in the plan network who will provide general medical care and authorize referrals to in-network specialists. Before you choose an HMO, make sure the doctors, hospitals and other health care providers you prefer to see are in the HMO’s network.

The second group is a PPO or Preferred Provider Organization. PPO's are a second type of managed care health plan. A PPO provides a large network of physicians, hospitals and other health care providers — usually larger than an HMO. Another important difference is that unlike an HMO, you can see providers outside the network for any service at any time, as long as they accept Medicare and you’re willing to pay more out-of-pocket. With some PPO's you may need to pay the non-network doctor directly, and then file a claim for partial reimbursement.

An RPPO is a regional preferred provider organization. The "Regional" part of an RPPO simply means that the network of preferred providers is not limited to one state only but crosses state boundaries within a specified region.

All Medicare Advantage Plans (including HMO, PPO and RPPO plans) offer the same coverage as Original Medicare (Part A and Part B), and they often include prescription drug coverage as well. Many also offer dental, vision and hearing care, wellness programs and other health care benefits not included with Original Medicare so be sure to check around to find a plan that provides you with the coverage you want and need.

If you have questions or would like to see what Medicare Advantage Plan options are available to you, give me a call  or email me. We will set up a time to do a review and go over your options