For Caregivers

Before you pick up the phone to speak to a claims representative, you need to gather some information. Be prepared to give the person you talk with:

• Your name and your relationship to your care recipient
• Your care recipient’s birth date
• The insurance policy number
• The name and address of the organization that sent the bill
• The total amount of the bill
• The diagnosis code on the bill
• The Explanation of Benefits (if you are questioning an insurance payment)

When you start the conversation, ask for the name and telephone extension of the individual who is handling your phone call. If you need to call again, you will want to try to speak with the same person. Keep in mind that billing office personnel and insurance claims representatives are there to serve you. You are the customer. Be assertive. You should expect to:

• Be treated with respect and consideration.
• Have your concerns clarified.
• Have your questions answered with accurate and timely information.
• Be informed of any steps you need to take to move things along.

Here are some tips for communicating effectively with people who work in the health insurance system.

• Be Prepared. Before you call an insurance company, write down a list of the questions you have so you can handle everything in one phone call.
• Take Good Notes. Take notes about your phone conversations, including the name of the insurance representative, the date of the call and the information you were given. For convenience, put this in your care recipient notebook.
• Be Clear and Concise. State clearly and briefly what your question or concern is, what you need and what you expect.
• Be Patient. Health insurance issues can be frustrating and time-consuming. Accept that you will spend a certain amount of time navigating through automated telephone menus, waiting on hold and waiting for the claims process to be completed.
• Be Considerate. Most insurance personnel want to do their jobs well, and they have a tough job to do. Thank them when they have been helpful. Speak to them kindly. Assume that they are trying to help you.
• Follow Through. If the insurance company asks you to do something or to send additional information, do it right away. Don’t let it slide. This will help them get the bill paid. Above all, be persistent. Stay in touch. Keep after an issue until it is resolved.

Review this list of questions as you are planning and preparing for any interaction with the health care system (e.g., doctor visit, trip to the emergency room, hospital discharge planning session, etc.) The questions are organized by category. Select the questions that best fit your needs. Feel free to add your own.

About Medical Care in General

• What might have caused this illness?
• What is this illness called?
• Is this illness likely to go away on its own?
• Is the pain likely to diminish or go away?
• How do you want to treat this illness?
• What are other ways to treat this illness?
• What are the risks with these treatments?
• What is the likely future of this illness with the recommended treatment?
• Without the recommended treatment?
• What is the time frame for the treatment?
• Is a hospital stay necessary?
• What is the expected recovery time?
• What lifestyle changes can my care recipient expect in the future?

About Medical Tests and Procedures

• Is the recommended test or procedure necessary to confirm or disprove a diagnosis?
• Will the findings of the test change the way the disease is managed?
• What are the risks involved?
• What happens if my care recipient refuses to undergo this test?
• How expensive is the test and will it be covered by insurance?
• Will the test require a change in any of the medications my care recipient is taking?
• What are the chances of inaccurate test results?
• What is the test procedure?
• How will the test feel? Will it be painful?
• How should I help my care recipient prepare for this test?
• Will my care recipient need help getting home afterward?
• Who will interpret the test results?
• Will someone call with the test results or should I phone for them?
• Can test results be sent directly to me or my care recipient?

About How the Doctor’s Office Works

• What days/hours is the office open?
• How are medical emergencies handled?
• When is the best time to reach the doctor by phone, fax or e-mail?
• Which method of communication does the doctor prefer?
• Who can answer questions if the doctor is not available?
• Who can I call after hours or when the doctor is away?

Regarding the Costs of Medical Care

• What private insurance plans do you accept?
• Do you accept Medicaid/Medicare assignments?
• What costs are covered by Medicaid/Medicare? Supplemental insurance?
• What costs are not covered by insurance?
• Approximately how much can I expect to pay in the long run for treatment?

Regarding Discharge Planning As part of the discharge planning process, many issues related to the patient’s care need to be resolved. As soon as you know your loved one is going to be admitted to the hospital, find out who is in charge of the discharge process and arrange a meeting to gather specific answers to the following questions.

• Where is the patient going to go after discharge? (Return to the previous setting? Go someplace else temporarily? Move permanently to a new location?)
• Who will provide additional home health care if it is needed?
• Does the patient need any home health equipment? What kind?
• Do physical and/or occupational therapy visits need to be arranged?
• What additional services may be needed and for how long (e.g., Meals-on-Wheels, hospice care, housekeeping, etc.)?
• What paperwork needs to be processed to get these services lined up?
• How will the added expenses be paid for?
• What additional skills do you need to learn so you can care for your loved one properly?

10 Tips for Family Caregivers

1. Caregiving is a job and respite is your earned right. Reward yourself with respite breaks often.
2. Watch out for signs of depression, and don’t delay in getting professional help when you need it.
3. When people offer to help, accept the offer and suggest specific things that they can do.
4. Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
5. There’s a difference between caring and doing. Be open to technologies and ideas that promote your loved one’s independence.
6. Trust your instincts. Most of the time they’ll lead you in the right direction.
7. Caregivers often do a lot of lifting, pushing, and pulling. Be good to your back.
8. Grieve for your losses, and then allow yourself to dream new dreams.
9. Seek support from other caregivers. There is great strength in knowing you are not alone.
10. Stand up for your rights as a caregiver and a citizen.

Here is a link to a website you may find helpful: Children of Aging Parents

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