Patient Advocate Foundation (PAF) programs and services are fully operational. As the coronavirus spreads across the country, PAF wants to make sure you have answers and resources to support you during this uncertain and stressful time. For resource, FAQ’s and educational webinars addressing the coronavirus pandemic, please visit our COVID Care Resource Center
   
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Category Archives: Interacting With Your Insurer

Insurance Challenges with Medication

This article discusses common insurance challenges that may happen when you're trying to access your medications.

Understanding Drug Tiers

In this article you will learn that one of the biggest healthcare barriers patients hit can be navigating the details of their prescription drug coverage options. If you know that you’ll need prescription drug coverage, it is important to research and choose a plan that covers your medication. Under a healthcare plan, the list of covered prescription drugs is called a formulary. The formulary is usually divided into tiers or levels of coverage based on the type or usage of the medication. Each tier will have a defined out-of-pocket cost that the patient must pay before receiving the drug. During…

What Do I Do if I Can’t Get Answers From my Insurance Company?

This article describes that sometimes it's not much fun trying to get answers out of your insurance company. Typically, each time you call, you speak with a different customer service representative and you may get different answers to a question you have. This inconsistency is really frustrating and upsetting, but here are some tips that might help you communicate with your insurer. But remember when speaking with them:

Understanding Your Explanation of Benefits (EOB)

This article discusses that every time you receive care from a provider or file a claim for services received, your insurer will send you an “Explanation of Benefits.” This form is not a bill. It explains what medical treatments and/or services were provided and the amount the insurance company will pay towards any covered charge.

Out-of-Network Costs and How to Handle Them

This article explains that as health insurance plans change and options vary, the same holds true for providers and health care facilities. Although there may be more treatment alternatives for patients available now, that doesn’t necessarily translate into more treatments covered. Because out-of-network costs add up quickly, it is important you become familiar with your plan and whether your health care provider is in your network.

Explaining Your Explanation of Benefits

This article discusses that although most people have heard of an Explanation of Benefits, commonly referred to as an EOB, they may be unsure of what it means. After you’ve visited a doctor, clinic or hospital, you should receive an itemized list summarizing the services provided to you. This is sent to you by your insurance provider and explains what portion of your medical services your insurance will cover versus what portion you are responsible for paying.

Preventive Healthcare

In this article you will learn that preventive healthcare services are now covered under the Affordable Care Act. Offering free annual preventive healthcare visits for patients will hypothetically lower healthcare costs and improve health across the nation. The thought is that if you find a disease in a patient early and are able to treat it, not only will you prevent the disease from progressing, you’ll save money on treatment, and you’ll prevent pain and suffering down the road.

What Does an EOB Statement Look Like?

This article explains that EOB formatting will vary from insurance company; however all EOBs should contain the following information. Each section of this sample EOB corresponds to the following explanations. Enrollee Name and Policy Number: Identifies the policyholder.

What’s Reasonable? What’s not? Learn how to read those bills!

If you’ve been diagnosed with a chronic, debilitating or life-threatening illness, chances are you’ve found yourself staring at complicated bill for services you’ve received. If you don’t understand some of the items on the bill, you’re not alone. Learn how to decode your medical bills and know exactly what you’re being charged for and how much it should cost.