​Why do we like super heroes so much?  What makes someone a Superhero?

Superheroes are powerful.  Perhaps the mystery of their true identity aids in their power? Superheroes fight for justice.  They take down the “bad” guy to help their community.
Superheroes are omnipresent.  Oftentimes, superheroes are standing right next to you.

At Cancer Patient Services, we meet superheroes every day.  They aren’t usually wearing a costume (but quite frankly it would be pretty awesome if they did), yet they are superheroes just the same. 

Our superheroes can come in the form of an individual who wants to volunteer because they are ready to give back to an organization that helped them or a loved one.  They help us fold mailers, clean medical equipment, and man our front desk.  They come not to be recognized or applauded.  And, they can be most often heard saying, “I will help wherever you need me.”
When they remove their "masks",we recognize them as caregivers who selflessly take care of their loved one who is fighting cancer.  We know they are the type of hero who takes off work to bring a friend to treatment, run their friends' child to soccer practice or willingly just sits with their friend when they are having a tough day.

Superheroes can be donors, as well.  They support our mission through the donation of purposeful funds, equipment, supplies or raffle and auction items to be used at our events. These superheroes don’t do it for the recognition, either. They see the important work CPS is doing locally for their coworkers, neighbors, friends or family and they want to help us continue our programming. We receive gifts from corporations, organizations and individuals.  We receive food for our Survivor Day celebration.  We are given the use of facilities to hold fundraisers.  The list goes on...  We also receive monetary gifts and they come in all forms: large gifts supporting programs for years or a $5 donation from a client who appreciates the help he has been given.  Each gift is a special "power" our superheroes offer us and we are grateful.

So look around you, there are super heroes everywhere.  They might not be sporting a super cool costume or have a totally awesome superhero name, but they are there.  They are doing good work right here in our community because it matters and we each can do something.

Cancer Patient Services appreciates all of our superheroes, cape or no cape!!
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On Sunday, May 22...
We hosted our first "SUPER HERO PARTY" honoring The Braden Kramer Foundation {www.bradenkramer.org} and featuring our new friends with Kasie Helps Kidz {www.khkidz.org}. The photo above was taken at The Children's Museum of Findlay with a local group called The Super Hero Alliance who volunteered to come in costume and help raise childhood cancer awareness.
​More photos can viewed here: https://goo.gl/OhndBK 

{Photo borrowed from FOX Business's article: How to Spot Medical Billing Errors}

​Something isn’t right.  I think there might be a mistake on my medical bill.

​We talked about your Insurance ID card and then gave you some terms you will see on your Explanation of Benefits.  Now let’s talk about mistakes.  Yes, they happen.  Even though physicians and medical providers use electronic medical records, medical billing still relies on people and people make mistakes…

But before we talk about figuring out mistakes, let’s take a look at the process of filing an insurance claim.  I think knowing this information can be helpful in figuring out where the mistake might have occurred.

For the sake of this example, let’s make this a fairly easy appointment.  You went to your Family Doctor for your annual check-up (you are getting an annual check-up, right? Ok that is probably a whole separate blog post) and during that check-up you have some blood work drawn.
You finish your appointment with the doctor and go check out.  You know you owe $35 for the office visit.  You pay the co-pay and get your receipt for your payment and leave the office.  After you leave, your doctor’s office sends your appointment information to your insurance carrier for payment.

Once your insurance carrier receives the information from your doctor, they then compare your services to your insurance plan to verify how the claim should be paid.  Once that process is completed, an Explanation of Benefits is generated for you.  On that Explanation of Benefits, information is provided as to how your claim has been paid.  It could tell you that you do not owe any additional money to your doctor or that you do have additional responsibilities to pay for that appointment.  If you owe additional money, you should receive a bill from your doctor’s office. If your Explanation of Benefit amount and the doctor’s bill match, you should pay your outstanding bill.
 
Now that is how it is all “supposed” to work.  But what if it doesn’t?  What if you don’t ever receive an Explanation of Benefits from your insurance carrier?  What if you do receive an EOB, but it doesn’t look right? Perhaps it says you owe more than you think you do.  With any of these situations, what should be your first step?

1. Contact your insurance company.  You will need to locate the number on your insurance id card that references billing.  Or, if you have an old EOB, look for the phone number that is for questions on that EOB. 
2. You will need to have your name, your policy id number, group id number, date of the medical appointment and any other receipts or paperwork relevant to that date.  Unfortunately, you might have to be on hold for quite a while.  Therefore, you want to have everything at your fingertips so you won’t have to call back.
3. Depending you what you find out from your conversation, you might have to have your doctor resubmit the claim or the insurance company to reprocess the claim.  Either way, do not pay the doctor until all questions have been answered and the claim has been processed correctly.

If this all sounds way too complicated and frustrating and you are a client of Cancer Patient Services, please reach out to us.  We would be happy to work through these issues on your behalf.  Call us at 419-423-0286 to make an appointment.

We found this Consumer Reports article to be helpful in decoding medical billing errors.

What is this EOB thing?
​
So, what is an Explanation of Benefits and why do you receive this from your Insurance carrier?  The form is documentation of how a claim for health services were processed.  The form provides you information on what services you received, what the health provider charged for those services and then, according to your health insurance policy, what money you owe the medical provider after the insurance adjustment.  Makes sense, right?  Well, why are these things so doggone hard to figure out, then?! 

Again, there are some terms that you need to understand that will help you decode your EOB:

• Procedure Code or CPT – This code tells the insurance carrier what service you received from your medical provider. 
• Amount Billed/Amount Submitted – This is the cost of the medical service that was billed to the insurance carrier by your medical provider.
• Not covered – This term refers to medical services that are not covered by your health insurance policy.  For example, most insurance policies don’t cover cosmetic procedures like face lifts. 
  • Or, if you were injured at work, your personal health insurance would not cover any medical services. Work injuries need to be filed under your organization’s Worker’s Compensation policy.
• Discount – The reason individuals and organizations purchase their health insurance through groups is to receive discounts on the services.  Similar to joining Sam’s Club or Coscto, your membership in that group {i.e. Medical Mutual, UnitedHealthcare, Cigna, etc.} gets you discounts.  The discount reflects the amount taken off from the amount that was billed by your medical provider to your insurance carrier. 
• Deductible – A deductible is the amount you need to pay first before your insurance starts to pay on your medical services.  The deductible is calculated AFTER any discounts you receive from your insurance carrier.  Deductible dollar limits can vary from $500 to $10,000. Once your deductible has been met, meaning you have paid for medical services up to that dollar limit, your plan can do one of two things:  (1) start paying the rest of your medical expenses at 100% or (2) you have a co-pay.  We will discuss co-pays...
• Co-insurance – A co-insurance is when the insurance carrier shares the cost of medical services with you.  Co-insurances generally go into effect after you have met your deductible.  The cost sharing can depend on a couple of things: (1) your insurance policy and (2) whether you received services inside or outside of your network.  Generally, if you choose services inside your network your co-pay will be less than if you went outside the network. 
• Network Providers - The network is the group of medical providers that your insurance carrier has negotiated discounts with.  So they are able to share those savings with you.
• Co-payment – Yes this is different than co-insurance.  Confusing, right?  Co-payments are the flat dollar amounts that your insurance plan may require you to pay for each office visit.  These can vary from $10 to $35 per office visit.  Unfortunately, co-payments are not included in your deductible, co-insurance or maximum out of pocket expenses.  Co-payments are generally just for office visit charges and do not apply to other medical services you might receive.
• Maximum out of pocket – Maximum out of pocket is the maximum dollar amount that you will spend on medical services each year.  The Maximum out of pocket number is a total of your deductible and your portion of the insurance co-pay.  *A reminder that Deductibles and Co-insurance are annual amounts.  You start back at zero at the beginning of your insurance year, which often follows the calendar year.
• Patient Responsibility – This amount if what you owe the medical provider.  If you have met your deductible and co-insurance, this amount could be zero.  But if you have not paid out the maximum out of pocket amount, you will have an outstanding balance. 

​Phew!  That was a lot of information for one blog post...  Still have questions?  Send me them below or if you would rather email them to me, please do at cmetzger@cancerpatientservices.org
The next blog post will go over what to do if you think there is a mistake.

Pictured: Client, Laura Cavitt, reviewing her medical bills and explanation of benefits with our Patient Navigator, Joanne Reinhart

Is it a foreign language?

Trying to figure out your health insurance carrier’s forms and letters are a nightmare.  And, that is when you aren’t sick.  So, imagine you are a cancer patient or you have some other chronic or acute disease, and you must understand that it can be downright maddening. 
Therefore, I thought it might be a good idea to write a Blog post about "How to understand your Health Insurance policy". 
But, as I sat down to write out a simple How-to blog, I quickly realized I couldn’t make it short and simple. Hallelujah, we have a 3 part series!  

1. First, I will explain some common terms you see on your ID Card.
2. The second post will explain some terms to help you understand your EOB a little more. 
3. And the last part of the series, I will talk about what to do if you think there is a mistake somewhere.  And yes, they happen more frequently than you think. 

Health Insurance is a complicated thing.  But, I am going to try and break it down into some more digestible chunks for you.
Let’s get started with some terms that you should find on your insurance ID card:

• Group Number – This is the number assigned to the group that is purchasing your insurance.  It could be your employer, an organization like the Chamber, or the group number of the insurance broker where you purchased your individual coverage
• Plan Number – Not everyone has a plan number.  But if you work for an organization that offer different health insurance options, you should have a plan number.
• Identification Number – Prior to HIPAA this number was always your social security number.  But now it is a unique identifier to the insurance carrier specifically for you as the insured.  The ID number refers to the person in the family that is carrying the insurance.  That is whoever is paying for the health insurance coverage.

​I hope this helps you understand your Insurance ID card a little more.  Stay tuned for Part II:  What is an EOB?  And, how can I figure out what it is supposed to be telling me?
But if you have health insurance questions in the meantime, please post them below.  Or, you can email me directly at cmetzger@cancerpatientservices.org.