Medicare: Claims - How To Find Professional Assistance
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If you have a problem with a Medicare claim and cannot handle it yourself or prefer not to, there are people with expertise available to help. For instance:
- People who work for your disease specific non-profit organization
- Non-profit organizations have as many levels of assistance in health insurance as there are non-profits. The key is to find a person in the organization with the experience, knowledge and determination you need.
- There is rarely any fee at all for such services. If there is a fee, it is usually an affordable sliding scale based on income.
- Even if the organization does not have someone on staff that provides this kind of assistance, it will probably be able to refer you to other competent organizations or individuals.
- A national organization which helps with appeals is Patient Advocate Foundation .
- Staff at your doctor's office or treatment center
- Often, people at your doctor’s office are very knowledgeable about advocating with Medicare – particularly if they treat a large number of Medicare beneficiaries.
- If your doctor contracts with another company for billing and insurance services, the odds are the people in that organization won’t be much help to you since they rarely work directly with patients. Still, it can’t hurt to ask.
- Your local State Health Insurance Assistance Program
- Through a national program called The State Health Insurance Assistance Program, or SHIP, the federal government funds organizations around the country to provide free assistance to Medicare beneficiaries with respect to issues and problems.
- Through grants directed to states, SHIPs provide free one-on-one counseling and assistance via telephone and face-to-face interactive sessions to people with Medicare and their families.
- Trained counselors offer information, counseling and assistance to Medicare beneficiaries on a wide range of Medicare, Medicaid, and Medigap matters, including, Medicare Advantage health plan options, long-term care insurance, claims and billing problem resolution, information and referral on public benefit programs for people with limited income and assets, and other health insurance benefit information.
- In addition, SHIPs support efforts to inform Medicare beneficiaries about fraud and abuse.
- Find a counselor:
- At www.SHIPTalk.org . Click on "Find A Counselor" or
- Call Medicare at 800.MEDICARE (633.4227) and ask for health insurance counseling.
- Claims Professionals
- If you decide to hire someone to assist you with your Medicare issue, keep in mind that anyone with or without experience can hang out a shingle and claim to be an advocate for claimants against Medicare.
- Ask friends and acquaintances, disease specific non-profit organizations, and staff at your doctor's office for names of people to call.
- The Alliance Of Claims Assistance Professionals, www.claims.org/ , maintains membership standards and requires each member to pass a test or series of tests on insurance claims handling. Their site contains a list of all their "certified" members Expertise with Medicare will vary among their members.
- Another organization to consider is Elderserve, Inc., Tel. 800.234.0507, www.elderserve.com/
- If you choose to hire an individual, in addition to looking at the questions raised in What To Look For In A Professional To Help With Claims:
- Ask for references of people they've helped in the same general area as your problem and contact them.
- Get all fees and costs in writing.
- Ask for a written statement that outlines your problem and what goal she wants to accomplish. To be extra careful, ask for proof that she carries Error & Omissions or Malpractice insurance. Such insurance provides some recourse in case of bad advice.
- Watch out for "guarantees" of any kind. Help with claims is not an area where guarantees can generally be givn.
- While an attorney can be of enormous help in many Medicare situations, attorneys can be expensive. Jacques M. Chambers, a benefits specialist (www.helpwithbenefits.com) recommends that an attorney should be your last resort after you've exhausted all other sources of assistance.
- As with other types of assistance, it is the individual not the title that determines how much help the person will be able to provide. Not all attorneys have the knowledge and experience necessary to advocate on Medicare issues. Others specialize in it.
- To find an attorney who knows Medicare, ask your friends, members of your support group, and your disease specific non-profit organization for names. Local bar associations usually maintain referral lists of attorneys by area of practice. The area you are interested in is "Medicare." (For contact information for your local bar association, see:http://www.abanet.org/barserv/stlobar.html ).
- For help finding a low cost or free attorney, click here.
- For additional information about choosing an attorney, see How To Choose A Lawyer.
Look for a person who has expertise and experience in dealing with Medicare -- preferably with issues like yours.
It is advisable to keep a record of your contacts with the person assisting you. Even though the person works in your interest, keep a written record of your contacts with him or her -- just as you would if you were dealing directly an insurance company.
- Make notes about each of your phone calls, including information such as with whom you spoke, when, what was discussed and what actions, if any, each of you agree to take.
- If you give information orally, follow up with a confirming e-mail or letter. Save a copy.
- If you receive information orally from the professional who helps you, write to the person confirming the information.
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