I recently read an excellent article by Anne Tergeson of The Wall Street Journal called "A Little Help With the Bills" that highlights the on-growing financial burden facing all Americans today.
Anne writes about Money Managers now taking on medical claims filing as one of their new services they provide for clients. While they may be good people to manage your assets and assist in common bill paying, they lack the necessary background and experience to properly coordinate your healthcare billing requirements.
It's one thing to look over your bills and help you pay them; it's quite another to identify that all medical services were paid correctly by the Insurance Company, appeal those which were not and check the Provider is billing the appropriate amount. Plus, medical insurance policies are more complex than ever. The most successful Money Managers, Trust Officers and Investors recognize the need to outsource their clients' medical paperwork to a Claims Assistance Professional (CAP). These skilled professionals have extensive training and
experience in the medical, nursing, insurance and claims arenas. In many cases, CAPs are licensed and bonded by State Insurance Departments and maintain continuing education requirements.
The primary goal of the CAP is to relieve patients and their families from the frustration, confusion, stress and time related to managing medical bills and claims activities. In addition, the CAP ensures the client is maximizing reimbursement consistent with their benefits and minimizing unnecessary out of pocket expenses. In other words, a CAP manages your medical expenses in order to leave you with more money in your pocket to spend or invest elsewhere. A CAP directly contributes to the preservation of your assets just as your Money Manger does with your personal wealth.
Most CAPs operate in a similar process. The client sends all their medical bills, statements and Explanation of Benefits (EOBs) from the health insurer to the CAP. Respected national services like Claims Security of America instruct clients to not pay any bills until reviewed for accuracy. This is perhaps the most important first step in the system. If the CAP intervenes with the insurance company and the provider to verify that reimbursement and billing are correct, the client is then notified in a timely manner when to pay and how much to pay. This simple compliance procedure provides the client with peace of mind and maximum reimbursement.
CAPs generally charge in one of three ways or a combination thereof:
1. Flat annual fee
2. Hourly fee
3. Percentage of recovered reimbursement.
In most cases, the services provided by CAPs pay for themselves in terms of the dollars recovered that were previously unknown to the client. Most people have no idea their insurance or their doctors may actually owe them money. And don't forget the added peace of mind you'll enjoy too!
In addition to the traditional medical bill management and claims assistance, some CAPs offer additional value-added benefits. CAPs regularly consult clients regarding the Medicare program including those entering it for the first time. CAPs review the various components of Medicare including Parts A, B, C, and D. Understanding open enrollment options for the under 65 crowd and evaluating alternative health care programs and services like home health care, skilled nursing care, assisted living and long term care are all services that can be rendered by CAPs.
Ask your Money Manager today to look into retaining a Claims Assistance Professional. Ultimately, it will save even more of your money and give your Manager time to do what he does best.
Hello Harvey,
ReplyDeleteI appreciate your comment and do recognize your skills and expertise. As a DMM and health advocate for senior clients, I would most certainly refer some of the more complex health insurance issues including appeals to a CAP. On the other hand, I have been very successful in helping my clients with the more routine types of medical insurance problems they might face. For example, one of my clients has received a bill from a hospital many times for nearly $1,000. She was worried it would go to Collections. After continual follow-up on my part, the issue has been cleared up and her insurance company is taking care of the bill.
Sincerely,
Amie Hyman
President/Owner
Heartfelt Solutions for Seniors, Inc.
Willow Springs, IL
www.heartfeltsolutions.net
Nice article; exactly on point. I actually have a client who used his personal money manager to keep track of his families’ medical bills. It didn’t work out too well. Now, both the client and his money manager are happy to send me anything medical.
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