What caregivers need to know about working with health insurance

Caregivers often step in to manage personal affairs, including health insurance. 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.

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.

#1 Get permission to speak on the member’s behalf

“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 Personal Representative Form. 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.”

#2 Create a complete file of the patient’s medical information

Make sure to organize the patient’s medical information in one place. This way, you’ll have easy access to critical data. This file should contain:

• Diagnosed medical conditions
• A list of all doctors
• Medical, dental, and vision insurance information
• Medical records and history
• Medicines
• Medication allergies

#3 Many of your health coverage questions are already answered in the member’s portal

“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.”

#4 Think of the provider’s office and the insurer as a team

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.

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.

#5 If you have coverage questions, call before services are rendered

“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. Answering these questions before you get the service rendered will help you get the care you need and avoid out-of-pocket costs.”

#6 Gather data in advance of calling a health insurance plan with questions

“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.”

#7 The patient may need care management services. Health insurance can help.

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.

“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.”

-Lauren Domings, Customer Service Supervisor at Mass General Brigham Health Plan

Visit our member portal to learn more.

Follow @MGBHealthPlan on Instagram, LinkedIn, Facebook, and YouTube.