How to get help with medical claims?

April 9, 2020 12:10 AM

My wife and I have a complicated set of health claims (multiple insurances, a number of claims) that we are having significant trouble keeping track of and getting paid. Neither she nor I have the bandwidth to deal with the coordination / back-and-forth with the insurance companies on this. We want to pay someone to help us with this. Are there people who help with this? I have read about “professional fiduciaries” is that right? We aren’t old / incapable, we just don’t have the time here. How the heck do we find someone to hire?
posted by The Ted to Work & Money (1 answer total)

Yes, but it depends on the depth of assistance you need.

If you just want to scream, "Argh, I don't want to look at this stuff!" but it's as simple as creating a chart with columns for the service, the insurance plans (primary, secondary, etc.) for each, and logging where it is in the process, so you don't underpay, overpay, or get on the bad side of a financial situation, then a professional organizer can do that.

As a Certified Professional Organizer, I've done that for my clients, sitting down at each session to see what EOBs (explanation of benefits) and bills they've received, tracking the information, and calling the insurance company (usually with them by my side, because of HIPAA rules) and speaking with the various billers (and the insurance company) to get that straightened out. Right now, with everyone in lockdown, you'd want to work virtually with a professional organizer. You'd start with NAPO.net (the National Association of Productivity and Organizing Professionals). Feel free to message me if you need any guidance with the search. (I've done this for lots of MeFites; am glad to help.)

A subset of professional organizers are financial organizers called Daily Money Managers, and some offer this kind of service, though it's usually one of many financial services they provide, not usually a standalone. Check out the American Association of Daily Money Managers. (Not just for seniors; often for super-busy people, those who travel often, etc.)

However, if the complications are more of a "This bill is wrong, THAT insurance was supposed to cover it, I need someone to argue on my behalf to challenge a claims denial," then you're going to want to look at some flavor of a Claims Assistance professional (sometimes called a medical billing assistant or a health insurance claims assistant). You can start with the Alliance of Claims Assistance Professionals. There aren't many of them, but assuming you still live where your MeFi profile says you do, you're golden.

Finally, if the MAIN thing you need is for someone to fight on your behalf, you may want to check into a Medical Billing Advocate, which strikes me as a claims assistance professional on caffeine -- their job is to be "fighty" for you. That would be the Alliance of Professional Health Advocates.

Whichever option you choose, depending on the depth and breadth of help you need, you're going to want to talk to a few specialists to get a sense of how they work, and how they work right now is going to be a bit different from their usual modes.

(For example, 95% of my own client work is normally with clients in their homes and offices, helping with organizing and time management; now that we're all sheltering-in-place, that's all moving to virtual organizing and time management assistance, with all of the attendance Zooming, emailing photos, sharing screens and sending documents. You'll need to be able to either scan and share your documents with whomever helps you, and/or grant them access to your online health/billing accounts...another reason why it's important to vet whomever you hire.)

Good luck!
posted by The Wrong Kind of Cheese at 12:43 AM on April 9, 2020