What caregivers need to know about working with health insurance

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id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text">What caregivers need to know about working with health insurance</span></h1> <div class="blog-post__meta"> Published by <a href="https://blog.massgeneralbrighamhealthplan.org/author/jim-milke" rel="author"> Jim Milke </a> on <time datetime="2024-11-13 14:45:00" class="blog-post__timestamp"> November 13, 2024 </time> </div> <div class="blog-post__body"> <span id="hs_cos_wrapper_post_body" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text"><p><span style="font-size: 16px;"><span style="color: #333333;">Caregivers often step in to manage personal affairs, including health insurance. </span><span style="color: #1b1b1b; background-color: white;">In recognition of National Caregiver’s Month, and to honor the work of caregivers everywhere, let’s look at how a caregiver can work better with a patient’s health plan.</span></span></p> <p><span style="color: #333333; font-size: 16px;">Continue reading to learn more from Lauren Domings, Customer Service Supervisor at Mass General Brigham Health Plan, for some insight on how to make the best use of a patient’s coverage. </span></p> <p><span style="font-size: 16px;"><strong><span style="color: #333333;"> </span></strong></span></p> <p><span style="font-size: 16px;"><strong><span style="color: #333333;">#1 Get permission to speak on the member’s behalf</span></strong></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><span style="color: #333333;">“The insurance plan will need permission to give out information on the member’s behalf. If the member is able, they should fill out a </span><a href="https://resources.massgeneralbrighamhealthplan.org/member/PERSONALREPDESIGNATIONFORM.pdf">Personal Representative Form</a><span style="color: #121212;">. This permits a person to speak for them,” Domings clarified. “This is usually found in the plan’s member portal. If a member is not able to speak for themselves, a power of attorney and health-care proxy/surrogate designation is necessary. It gives a caregiver or guardian the legal authority to speak with the insurance company.”</span></span></p> <p><span style="font-size: 16px;"><strong><span style="color: #333333;">#2 Create a complete file of the patient’s medical information </span></strong></span></p> <p><span style="font-size: 16px;"><span style="color: #333333;">Make sure to organize the patient’s medical information in one place. This way, you’ll have easy access to critical data. </span><span style="color: #333333;">This file should contain:</span></span></p> <ul> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">Diagnosed medical conditions</span></span></li> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">A list of all doctors</span></span></li> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">Medical, dental, and vision insurance information</span></span></li> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">Medical records and history</span></span></li> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">Medicines</span></span></li> <li><span style="font-size: 16px;"><span style="color: #333333;"> </span><span style="color: #333333;">Medication allergies</span></span></li> </ul> <p><span style="font-size: 16px;"><strong><span style="color: #333333;">#3 Many of your health coverage questions are already answered in the member’s portal</span></strong></span></p> <p><span style="color: #333333; font-size: 16px;">“So many of the questions caregivers ask relate to coverage, claims, copays, or co-insurance. Most can be answered in the member portal,” said Domings. “I often refer people to the Schedule of Benefits (SOB) or the plan’s Member Handbook, which includes information on what’s covered.”</span></p> <p><span style="font-size: 16px;"><strong>#4 Think of the provider’s office and the insurer as a team </strong></span></p> <p><span style="font-size: 16px;">You often need to speak with the provider and insurer to get coverage questions answered ahead of time. Think of both parties as a team to help patients get the most out of their coverage.</span></p> <p><span style="font-size: 16px;">Mass General Brigham Health Plan is proud to be a part of the Mass General Brigham health system. While our health plan works with all providers, care coordination is optimized for patients and members receiving care within the Mass General Brigham health system.</span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><strong><span style="color: #121212;">#5 If you have coverage questions, call before services are rendered </span></strong></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><span style="color: #121212;">“Knowledge is power, so knowing what’s covered and how much you’re expected to pay will give you peace of mind.” Domings added, “It can also help you maximize the benefits. </span>Answering these questions before you get the service rendered will help you get the care you need and avoid out-of-pocket costs.”</span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><strong><span style="color: #121212;">#6 Gather data in advance of calling a health insurance plan with questions </span></strong></span><br><br><span style="font-size: 16px;">“The first step to access care is often confirming that the member’s provider is in-network,” explained Domings. “You can determine the provider's participation status by asking them to confirm their National Provider Identifier (NPI) along with the Facility Name & NPI; so we can identify the exact provider or facility for confirmation. Next, we usually confirm coverage and costs. For that, we ask for the Current Procedural Terminology (CPT) code or the Healthcare Common Procedure Coding System (HCPCS) code to understand if the service will be covered and if it may require prior authorization. It’s also important to note what the actual service will be. For example, if it will require inpatient care or if they are just going to a lab for bloodwork.”</span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><strong>#7 The patient may need care management services. Health insurance can help.</strong></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><span style="color: #121212;">A terminal illness or chronic medical condition can be overwhelming. The person may not fully understand the depth of their diagnosis. They might not feel they’re not getting the help they need. These are situations where our care managers can help. Speak with the patient’s health plan customer service department to get that process started. </span></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><span style="color: #1b1b1b; background-color: white;">“</span><span style="color: #333333;">Being a good caregiver for a loved one can often feel overwhelming, but it is also a blessing because you can play a significant role in making sure they get the best care that they deserve.”</span><span style="color: #333333;"> </span></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><em><span style="color: #333333;">-</span></em><em><span style="color: #1b1b1b; background-color: white;">Lauren Domings, Customer Service Supervisor at Mass General Brigham Health Plan</span></em></span></p> <p style="margin-top: 0in; margin-right: 0in; margin-bottom: 12pt; padding-left: 0in;"><span style="font-size: 16px;"><span style="color: #1b1b1b; background-color: white;">Visit our </span><a href="https://member.massgeneralbrighamhealthplan.org/"><span style="background-color: white;">member portal</span></a><span style="color: #1b1b1b; background-color: white;"> to learn more. </span></span></p> <p><span style="font-size: 12px; color: black; background-color: white;">Follow @MGBHealthPlan on </span><span style="font-size: 12px;"><a href="https://www.instagram.com/mgbhealthplan/"><span style="color: #003a96;">Instagram</span></a></span><span style="font-size: 12px; color: black; background-color: white;">, </span><span style="font-size: 12px;"><a href="https://www.linkedin.com/company/mgbhealthplan"><span style="color: #003a96;">LinkedIn</span></a></span><span style="font-size: 12px; color: black; background-color: white;">, </span><span style="font-size: 12px;"><a href="https://www.facebook.com/MGBHealthPlan/"><span style="color: #003a96;">Facebook</span></a></span><span style="font-size: 12px; color: #003a96; background-color: white;">, </span><span style="font-size: 12px; color: black; background-color: white;">and </span><span style="font-size: 12px;"><a href="https://www.youtube.com/@massgeneralbrighamhealthplan"><span style="color: #003a96;">YouTube.</span></a></span></p></span> </div> <div class="blog-post__links-container"> <div class="blog-post__links"> <a href="https://blog.massgeneralbrighamhealthplan.org" class="blog-post__back-to-blog"><span id="hs_cos_wrapper_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_icon" style="" data-hs-cos-general-type="widget" data-hs-cos-type="icon"><svg version="1.0" xmlns="http://www.w3.org/2000/svg" viewbox="0 0 448 512" aria-hidden="true"><g id="long-arrow-alt-left1_layer"><path d="M134.059 296H436c6.627 0 12-5.373 12-12v-56c0-6.627-5.373-12-12-12H134.059v-46.059c0-21.382-25.851-32.09-40.971-16.971L7.029 239.029c-9.373 9.373-9.373 24.569 0 33.941l86.059 86.059c15.119 15.119 40.971 4.411 40.971-16.971V296z" /></g></svg></span>Back to Blog</a> </div> <div class="blog-post__sharing"> <span id="hs_cos_wrapper_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_blog_social_sharing" style="" data-hs-cos-general-type="widget" data-hs-cos-type="blog_social_sharing"> <div class="hs-blog-social-share"> <ul class="hs-blog-social-share-list"> </ul> </div> </span> </div> </div> </article> </div> <section class="blog-related-posts"> <div class="content-wrapper"> <h2>Related Articles</h2> <div class="blog-related-posts__list"> <article class="blog-index__post blog-index__post--small" aria-label="Blog post summary: Caregiver tips: how to make homes safer and more comfortable for loved ones"> <div class="blog-index__post-inner-card"> <a class="blog-index__post-image blog-index__post-image--small" style="background-image: url('https://blog.massgeneralbrighamhealthplan.org/hubfs/iStock-1446888331.jpg')" ; href="https://blog.massgeneralbrighamhealthplan.org/ideas-for-making-a-home-safer-and-more-comfortable-for-caregivers" aria-label=" Featured image: Woman spending time with her elderly mother at home - Read full post: Caregiver tips: how to make homes safer and more comfortable for loved ones"> </a>  <div class="blog-index__post-content blog-index__post-content--small"> <h2 class="blog-related-posts__title"><a href="https://blog.massgeneralbrighamhealthplan.org/ideas-for-making-a-home-safer-and-more-comfortable-for-caregivers">Caregiver tips: how to make homes safer and more comfortable for loved ones</a></h2> Caregiving is an essential role taken on by family and friends for their loved ones. 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What caregivers need to know about working with health insurance