“TRICK OR TREAT” Don’t Be Tricked, Be Well Informed About Your AEP (Annual Enrollment Period) Medicare Choices!

GERIATRIC CARE MANAGERS HAVE TO DEAL WITH ALL SORTS OF PAYERS (INSURANCE COMPANIES) ADVOCATING FOR SENIORS AND THOSE WHO LOVE AND CARE FOR THEM ON A DAILY BASIS. WE KNOW WHAT YOU REALLY NEED TO KNOW ABOUT YOUR HEALTHCARE BENEFITS AND CLAIMS. NO TRICKS! FIND OUT MORE ABOUT YOUR INDIVIDUAL-ACTUAL NEEDS BEFORE YOU MAKE ANY DECISIONS! CONSIDER AN INSURANCE BENEFIT CONSULT, MEDICAL BILLING MANAGEMENT, BEST INSURANCE/LEGAL/FINANCIAL REFERRAL OR INSURANCE PROVIDER MEDIATION WITH YOUR LOCAL BOARD CERTIFIED GERIATRIC CARE MANAGER TODAY!

While assisting clients and care recipients with insurance issues is not always at the frontlines for geriatric care management advertisements, or what geriatric care managers might-mostly do; the truth is, we geriatric care managers must often-do whatever we can-do to help families make the best healthcare choices in the current senior care industry. So, offering insights as to the practical/hands-on basics of insurance benefits is a topic that comes to play in our work, everyday! Whether we choose it, or not! And more often- than not, is the complexed presentation in a case of medical billing management. We care managers help seniors with this time consuming, mind bending challenge more as the billing practice gaps grow.

Medical billing management exists in the day to day operations of care management since one of the key issues facing caregivers these days is the need for becoming more intuitive about maximum reimbursement from insurance policies, along with simply knowing what the benefits with a certain coverage are, or the “need to know” about organizing vital documents. It may sound odd, but many adult children are unsure about the particular benefits, coverages, and perks that their parents health insurance policies detail (or don’t). Under the current managed care system, this “need-to-know” issue is only growing, needless to say. New geriatric care management practitioners find this to be a very unwelcoming though necessary component of every day practice. Although we care managers will prefer to get into the heart of real caregiving issues, in a given case; such items as the resources, authorization, benefits and certifications for the care recipient in every case make medical billing knowledge a must! Not to mention, due diligence in the process of verification and utilization review for said benefits. Take for example who a patient sees first when he goes to his/her doctor? The front desk, right? They want to know “Who is paying for the day’s charges…” Care managers mediate, or go-between practice providers and practice payers daily in some way, either directly or indirectly. We are most helpful when families allow us to take charge of dealing with the medical providers and the accompanying payer(s). This is especially true in the case where we serve as conservators or manage and coordinate care for out of town adult children, for example.

It is common place now-a-days to see the likes of denied payments, UN-itemized hospital charges or worse, inappropriate charges and wrongful miscellaneous erroneous charges. I hear families describe how they are repeatedly denied coverage for certain medical or geropsychiatric costs. Many of the clients I see, will ask for help with provider (insurance carrier/payer) mediation to maximize their rightful home care benefits from their LTC policies. With the rising rates of current and trending home care costs, fishing all policies in house remains essential in resource tracking.

One of the continual growth patterns with Medical Insurance Billing Management services provided by your friendly local board Certified Geriatric Care Manager is with Insurance Benefit Checkups, Insurance Provider Consultation & Referral Process, Provider Mediation and/or Medical Billing Management, where we can assist in billing review or mediate with medical claims adjusters and/or proprietorships. A geriatric care manager is a great resource for anyone who is eligible for Medicare and Medicaid benefits, as well as being well informed about both government programs. AEP runs now through 12/7, or 10/15-12/7 annually! The bottom line is this. You can be tricked into choosing a senior healthcare insurance or other related senior service, if you are not well informed and know the basics about such areas as:

  • Medicare Parts A, B, C, & D- the basics
  • What’s the “advantage” and “disadvantage” of an Advantage Plan
  • Medigap policies- what is this- when/where and why
  • Medicaid Eligibility- who gets this and why
  • Long Term Care Insurance risks/benefits
  • Policy Riders- great benefit check-up resource
  • Estate Planning Documents- what are these and who prepares them
  • Important Personal Documents- do these need to be organized
  • Home Ownership Records- Is this a necessary safe-filing practice task
  • Estate Planning- ins and outs
  • Professional Advisors- which ones are best for you
  • Financial Matters- Is healthcare a budget item
  • Reviewing Medical Bills
  • Medicare Appeals
  • Medicare Rights
  • Veterans Benefits checkup
  • What Insurance Pays For (actually!)
  • Where Can I Get a “Medicare & You” Booklet
  • What Are Other Medicare Enrollment, Eligibility & Penalty Related Dates
  • What is “5-Star” Special Enrollment
  • And so much more… Don’t be tricked! Knowledge is power-
M

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