Advocating for Members with Special Circumstances
Once the initial shock wears off, the challenges of a being diagnosed with a critical medical condition can be overwhelming. What are the choices? What's covered? What's next?
- Obtaining pre-authorizations and prior approvals
- Understanding medical jargon
- Navigating health care networks and managing physician referrals
- Walking through medical bills and Explanations of Benefits (EOBs)
- Speaking to medical staff with them, or on their behalf
- Suggest community resources for services not covered by insurance
- And more
- Are born severely premature
- Have congenital defects
- Have pediatric cancer
- Experience a traumatic injury
- Undergo a transplant
Meet the Thompsons from Minot:
Even before he was born, little Palmer Thompson was diagnosed with spina bifida. It was just the beginning of a flood of medical bills and insurance statements for out-of-state specialists, surgeries and hospital stays. The Thompsons were overwhelmed.
Then they received a call from a BCBSND member advocate. "It was music to my ears," says mom, Angie. Among other things, the advocate took the time to handle the legwork and monitor claims so they were paid at the best possible level. "It's wonderful to know they're watching over us, and I can always call someone who is familiar with our family," Angie says. "I'm able to focus more on our two beautiful sons instead of worrying."