When speaking to your insurance company/plan, you may find that you do not have all the documents you need in front of you, or that you need to call back to get more information. Here are three tips to help you communicate effectively with your insurance company.
- Do everything you can to have the documents and information you need before you pick up the phone.
- While talking to a representative from your plan, you may need:
- Your name and address
- Your date of birth
- Your insurance policy number (and/or other information from your insurance card)
- Your Social Security number
- A Medicare Summary Notice (MSN) The Medicare Summary Notice (MSN) is a notice from Original Medicare that lists the health care services and items you received during the previous three months. It tells you what the provider billed to Medicare, the amount Medicare paid, and the amount you have to pay. The MSN is not a bill. See also: Explanation of Benefits (EOB). if you have Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , or an Explanation of Benefits (EOB)if you have a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan
- Any bills you have received, including the name and address of the entity that sent it, the total cost of the bill, the name of the Provider See Health Care Provider. and date of service, and the diagnosis code on the bill
- A list of questions you want to ask
- If possible, you should carefully read any documents you received from the insurance company before calling.
- While talking to a representative from your plan, you may need:
- Record information you receive during the conversation.
- Always write down the name and telephone extension of the plan representative handling your call. If someone is unable or unwilling to help you, ask to speak to a supervisor.
- Take notes, including the date and time of the call, the information you are given, and what you were told to do next.
- You may also want a trusted individual to be on the call with you to take notes and ask questions.
- Submit information immediately.
- If the insurance representative asks you to send something, do it as soon as you can. This will help ensure that the process moves smoothly. If you cannot act immediately, ask if there is a deadline for submission. For instance, for appeals of denials of care, deadlines for submission of materials are included on notices from Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). or your plan.
- Keep a copy of materials sent in the mail. In some cases, you may want to send materials via certified or registered mail.
Remember: Be patient! You may have to spend time on hold or navigating automated telephone menus before you can speak to a representative.