Friends and family often ask me for guidance about health insurance and how it works when they are dealing with a serious illness or injury. I tell them to call their health insurance company to find out what resources they may have available to help. Many insurance companies have programs that can help patients coordinate the best medical care with their insurance coverage.
When should I call my health insurance company?
Insurance company resources are most effective in the early diagnosis and planning stages of medical treatment. In other words, call as soon as you learn of your diagnosis and before you schedule any major procedures or pick up equipment for home use. Knowing about your insurance coverage and options will help you make the best-informed medical decisions.
What kind of resources does health insurance offer?
Insurance companies may offer various resources for all stages of your treatment. First, these resources can direct you to physicians and other medical services providers that accept your insurance. Then, like a good friend who also happens to be a nurse, they can offer ongoing guidance and support for your medical questions. Three resources that Pekin Life Insurance Company offers to insured patients are Case Management, Nurse Health Coaches, and Voluntary Specialty Networks.
Case Management Nurses help patients connect with providers who can meet medical needs promptly, conveniently, and at reduced rates. This can minimize your out-of-pocket expenses. At Pekin Insurance, Case Managers can help if you need:
• Medical equipment, such as a wheelchair, oxygen, or diabetic supplies
• Home physical therapy or nursing visits
• Injections at home or in a physician’s office
• Any kind of cancer treatment
Nurse Health Coaches provide ongoing answers and advice to help patients manage chronic illnesses such as:
• Diabetes – Type 1 or Type 2
• Asthma – Adult and Juvenile
• High Blood Pressure or High Cholesterol
• Coronary Artery Disease, Stroke, or Vascular Disease
• Congestive Heart Failure
• Chronic Obstructive Pulmonary Disease (COPD)
Voluntary Specialty Networks
(http://www.pekininsurance.com/customer-center/inquiry/member/volunteer-networks-of-specialty-providers/) give you access to experts and often more cost-effective providers who may otherwise be out of your normal PPO network. For example, Pekin Life Insurance Company uses the specialty network BridgeHealth, which gives patients access to the best providers across the United States for spinal, heart, hip, and other major orthopedic surgeries.
How do these resources work?
Here are real life scenarios to better understand how insurance company resources can benefit you.
This serious and chronic illness is life changing for patients and their families. While doctors provide treatment options and referrals to specialists, a Case Management Nurse can direct you to the most cost-effective preferred providers for the equipment and supplies you will need. They may refer you to a claim and benefits specialist who can explain what kinds of diabetic treatment and counseling are covered and how to get the best insurance coverage for those services. If you enroll in the free, insurance company-sponsored diabetes management program, the Nurse Health Coaches will continue to follow up and provide ongoing guidance to your family so you can effectively manage your diabetes.
Planning a Hip Replacement
Your physician recommends that you have a hip replacement. With Pekin Insurance, you can call BridgeHealth for a referral to one of the top hip replacement surgeons in the United States. That surgeon happens to be in Utah. BridgeHealth will arrange your transportation and all of your medical needs after surgery, including the medical equipment you will need at home during your recovery. The costs, including travel costs, will be bundled into one cost-effective surgical fee. How can they afford to do that? Their physicians have the best track records for shorter and more successful recoveries, so you will have lower overall medical costs.
If you are dealing with a serious illness or injury, be sure to take advantage of the resources your health insurance company offers. They want to help you “Get Well Soon!”
Client Support Supervisor