Overwhelmed by emotion and the details of his wife’s care, Highland Park resident Burt Munk didn’t have the time or energy to deal with the mountain of medical bills that poured in for his wife’s cancer treatments.
“I kept the bills in a shoebox,” Munk remembers. “I didn’t even bother to open them.”
A friend advised Munk to hire a woman who had formerly been a medical claims adjuster to sort out the mess. That was about 10 years ago, and Munk still retains the woman to check on the accuracy of every medical bill and insurance reimbursement that he and the employees at his small Northbrook firm incur.
When Munk first hired the woman, such consultants or “claims assistance professionals” were relatively rare.
But Bonnie Kuhn, president of Insurance Claim Processors in Deerfield, says that in the past five years there has been about a four-fold increase in the number of claims assistance consultants listed under “Insurance Claim Processing Services” in her local Yellow Pages.
Kuhn says dual-career, time-pressed parents represent a big portion of her business. She not only helps them with filing claims but also advises couples on which spouse’s medical coverage would be better to cover a particular situation.
“There are now laws that prohibit the duplication of benefits,” Kuhn notes. “But one spouse’s policy might have better reimbursement than the other’s.”
And people like Burt Munk, too overburdened with other concerns to deal with paperwork rivaling a complicated tax audit, also utilize claims assistance professionals. “It’s not at all unusual for people to stash away their bills in a shoebox, just hoping that they will someday disappear,” says Susan Dressler, owner of Health Claim Assistance in Wheaton.
The other instance where such consultants can come to the rescue is if a consumer is having a dispute with his insurer over whether he’s actually entitled to a reimbursement. Consultants often have more persistence and know-how about how to challenge a denial.
“Most people tend to just give up,” says Norma Border, national director of the National Association of Claims Assistance Professionals, Inc. (NACAP), a Downers Grove-based association.
“But if you challenge a denial and provide the right information, you have a 50 percent probability of getting coverage,” Border says. “And if you then pursue reimbursement through the various administrative appeals available with Medicare or commercial plans, you increase the probability.”
If you’re looking for help, you don’t have to hire a claims assistance professional, who typically charges an hourly rate of $30 to $60. You can try doing the job yourself, using tips from the pros (see accompanying box).
Moreover, the Illinois Department of Insurance has a consumer phone line (312-814-2427) that Chicago-area residents can call between 8:30 a.m. and 4:30 p.m. on business days to talk to a consumer analyst about how to file a claim, what information to provide and other questions.
Consumers can also come in, with or without an appointment, to receive free help, says deputy counsel Tim Cena.
Walk-ins must come to 100 W. Randolph St., Suite 15-100, between 8:30 a.m. and 4:30 p.m. “People can bring in all of their bills and paperwork, and an analyst will sit down and try to sort things out,” Cena said.
The Illinois Department of Insurance also has an ambitious program called SHIP (Senior Health Insurance Program), designed to help Medicare recipients understand and receive their benefits, including any due them from supplemental insurance.
SHIP offers a toll-free line (800-548-9034) on which counselors will offer seniors or their family members advice. The line is open Monday through Friday from 8 a.m. until 5 p.m.
Free walk-in help is also available at some 165 senior centers and other non-profit organizations from trained SHIP volunteers, says program director Kathy Claunch. Call the 800 number for the location nearest you.
Claims assistance professionals are not licensed by the state or any other regulatory body. But Claunch warns against hiring any consultant who is also in the business of selling health insurance, because that may conflict with the consumer’s best interests.
NACAP has just begun offering its members a competency test. So far only 64 of NACAP claims assistance professionals have been certified, Border says.
But NACAP does run a referral line (708-963-3500) that consumers can call for names of professionals in their area. All of the professionals registered on the consumer line must have letters of recommendation from clients, Border says.
And although claims assistance professionals charge an hourly fee, the charges are usually fairly minimal, especially compared to what the claims assistance professional can recover from an insurer. Most cases can be resolved in less than 10 hours, the consultants say.
Barbara Melman, president of Claim Relief Inc., Chicago, says that consumers can mail or bring in their bills to a claims assistance professional, and the consultant should be able to give them a ballpark idea of how much time it would take to work on the problem.
FILING A CLAIM
– Stay organized. Invest in some file folders, and keep bills from different hospitals and doctors in their own labeled file.
– Ask questions. “Too many people are afraid to talk to their doctor. Ask why tests are being performed, and whether or not the procedure is covered by Medicare,” says Susan Dressler, owner of Health Claim Assistance in Wheaton.
– Seek proper approval. Many managed-care facilities and HMOs won’t cover certain treatments unless prior approval is given by the appropriate channels first.
– Call your insurer. If you develop a relationship with a claims representative, it could cut the red tape and speed your reimbursements.
– Be suspicious. Sometimes claims are denied because minor details are incorrect, such as the code for a procedure. Mistakes can be made by the doctor’s office, the hospital or the patient.
