By Martine G. Brousse (not AI!)
"The Medical Bill Whisperer"
Patient Advocate, Certified Mediator
AdvimedPro
August 26, 2024
Watch the video: https://youtu.be/rPbOrb63y_Y
What is this "Access to Care" you may have heard about? Is it important? How to take advantage?
A. What is it?
1. "Access to Care" is a healthcare strategy, implemented, especially the last few years,
to improve health results by helping people obtain medical services of a high quality
through affordable insurance coverage.
2. It is also a patient's right under the terms of a policy and by certain legal mandates.
3. "Access to Care: usually means three things: affordability, availability and timeliness.
· Affordability is a huge problem: Healthcare is expensive. The US spends more per capita on healthcare and medical costs than all other Western countries. Premiums for health insurance are so prohibitive that at least 10% of the US
population does not have insurance at all, with many more under-insured. All of these
healthcare dollars do not lead to better outcomes: the US leads the Western world in
lower life expectancy and % of adults with higher number of chronic conditions.
People with no or little insurance coverage are less likely to have a Primary Care Physician
or seek care unless an emergency, and they'll be less likely to afford that care once it's too
late. And for the underinsured, they still face difficulties managing those costs, with a high
rate of medical debt and bankruptcies.
· Availability in rural areas is a major challenge for 60 million Americans at significant
distance from a physician or a hospital. Medical equipment, facilities or specialists are
harder to come by. Insurance networks offer less choice or availability. This also translates
in very troublesome health outcome statistics.
· Timeliness and connection: getting prompt appointments with practices that meet
your specific needs has become more problematic, as growing numbers of physicians,
getting paid cash directly by patients, remain out of networks. An insurance network of
providers, extensive enough to provide timely appointments but also convenience, can be hard to manage. Convenience is proximity to your residence, as well as expertise, language, preferred gender, hours of operation, easy parking, a supportive staff, telehealth sessions, facilitated communications and more.
B. What does it mean for you?
1. Your existing policy has a duty: to provide you with a large-enough list of In Network providers, within 15 miles from your residence (30 in more rural areas), offering appointments within a short period of time, depending on the urgency and complexity of the medical issue.
2. Your existing insurance can be forced to pay In Network rates to Out of Network providers when you are forced to use their services:
· no qualified or experienced In Network provider
· too-long waiting list for appointment
· In Network provider does not accept new patients, treat your gender, age or condition
· In Network provider only offers teledoc visits, or not at all
· In Network provider's location and hours are too inconvenient, limited or difficult
3. If you are uninsured, you can buy a cheaper, subsided insurance plan:
· Visit healthcare.gov, and see how, or if you can qualify. Links to specific States' Marketplace are provided
4. COBRA is part of Access to Care
If you recently lost your insurance, because you were fired, retired, quit or are in between
jobs, don't forget to consider Cobra. This is your right to continue receiving the same
insurance coverage your employer had been providing to you until now. Yes, you would be
responsible for the full payment of premiums. But you and your dependents would continue receiving guaranteed Access to Care and to medical services. HR should give you written
notice at the time employment stops, and an application to sign up for COBRA extension
of coverage. Make sure you return it within 60 days.
C. Take advantage
1. Free preventive care services provide early detection and lead to better outcomes and ultimately lower medical bills. Those free services include yearly well-visits, screenings, immunizations, lifestyle advice and support, early intervention, and more. Preventive services at no cost are available to all children and adults.
2. Free insurance services: your plan offers online and phone services at no cost to you, that can widen your access to medical care:
· 24/7 Nursing line for questions about prescriptions or basic non-urgent medical care, to help find an In Network specialist or request an emergency Rx refill
· 24/7 Mental Health Crisis line: although calling 911 should be the first step in an emergency, those counselors can help you locate In Network therapists, programs or facilities, as well as answer basic mental health questions
· Online resources include lifestyle recommendations and advice, Rx maintenance, sign ups for a telehealth visit, support groups and more.
3. ACA Marketplace subsidies for insurance premiums are available to those with low incomes or who cannot afford health insurance on the open market. You can enroll online through Healthcare.gov or through your State's own marketplace website. Additionally, marketplace plans offer significant savings on medical costs that other commercial plans may not be able to compete with.
4. Legal mandates: in addition to the Terms of Policy, your Access to Care is mandated by the ACA/Obamacare, as well as some States' legislature. Your insurance plan must be able to provide emergency, urgent or routine primary care to its members within a certain number of hours or days. Visit your State's Dept of Insurance website for more info.
5. Right to appeal: this means to request a review of how a claim was processed based on
specific circumstances, especially when you were forced to use an Out Of Network provider because no In Network provider was available. Argue precisely and clearly, and don't forget
to include
. A special authorization or reprocessing of your claim
for payment at a higher level should be approved.
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2024 @ the medical bill whisperer 2024
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