No matter what kind of healthcare visit or procedure you have, insurance can be confusing—so much so that it can sometimes feel like a completely different language. In addition to various companies, each individual insurance company has many, many policies. So, what works for someone with similar insurance might not work for you. That’s why we offer free insurance support for patients and clinics. Our team acts as a trusted guide to educate, address concerns and help you ask the right questions.
We work with you to do everything from verification of benefits to submitting the paperwork to insurance providers to requesting and receive pre-authorization. In the event that your request for pre-authorization is denied, we’ll investigate the reasons for denial and help to form and submit your appeal. We can truly help as little or as much as you need.
We sat down with Lindsay Fisk, Oticon Medical’s manager of customer reimbursement services, to learn more about how she helps hundreds of people navigate the world of insurance coverage. With over 500 authorizations complete, Lindsay and the rest of the team have a defined process that will get you on the right track for coverage.
Lindsay describes our process, which focuses on two-way information sharing and education, defining the right questions and taking action. “First, and most importantly, we listen. We make sure to fully understand what’s going on, then we can share all of the information that a patient needs to know.”
Once we have basic information from the patient, we discuss what the key aspects of insurance coverage actually mean. One of the most important terms is prior authorization, so we start with what that encompasses.
Prior authorization means that a clinic has to submit documentation to ensure that a patient medically meets the requirements of the procedure.
Next, we cover the numerical codes associated with office visits, the procedure and the equipment. These five-digit numbers are widely used in the medical field for billing and procedure identification, and the implant surgery is the same way. We’ll provide each code and explain exactly what that code represents.
Equipped with that information, together we can identify the right questions to ask your insurance company. Some of those questions include:
- Is this code a covered benefit under my plan?
- How much will the insurance company contribute? What percentages will they pay for various pieces of the process—80%, 100%?
While you’re asking the right questions of the insurance company, Lindsay and the team also work directly with clinics to help get benefit information for prior authorizations. This means that we make phone calls to understand coverage plans, submit documents and make notifications of approvals and denials.
After doing authorizations for over four years, Lindsay describes her job as continuously rewarding. “There’s nothing like telling a parent that their son or daughter is going to be able to hear,” she says.
Are you looking for insurance guidance for your bone anchored hearing system? Learn more about our free service here. Have questions for Lindsay and the insurance team? Let us know in the comments section below or Facebook or Twitter.