Musings of a Marfan Mom

Off Your Desk: Your Insurance Questions Answered

| 3 Comments

I’ve recently become aware of a company that really jumped out at me, so I wanted to be sure to tell you all about it! How many of us have spent too much time arguing with our insurance companies trying to get a new therapy for our kids covered, approval to have surgery at an out-of-network hospital, or help in understanding the 20 different bills that just arrived for one hospital stay? I know we have, given that each member of our family has a chronic condition.

Off Your Desk is a company that takes the insurance headache off your hands. It takes only 10 minutes to sign up, and all you do is mail them all your insurance related paperwork in a pre-paid envelope. From there, Off Your Desk advocates for you, makes sure you are getting all the reimbursements you deserve (and not being over-charged!), and helps explain your insurance to you. They even work with Medicare/Medicaid.

They offer three basic plan options:
The Catch-up Plan is for those who have a lot of existing paperwork to go through (for example, after a major surgery). The average customer on this plan recovers $2500 within the first 90 days of working with Off Your Desk.

The Ongoing Support Plan is particularly useful if you’re someone who has a lot of doctors’ visits.

The Member Advocacy Plan is for those of you who just want to be able to have access to a professional to ask questions to so that you can handle your insurance paperwork on your own.

Custom plans are also available, including one tailored specifically to expectant mothers.

Off Your Desk is also looking to help the general community. They’re starting a Facebook group where fans can ask insurance questions. Each week Off Your Desk will feature one question to answer. Off the top of my head I can already think of a couple that I get asked a lot and I bet Off Your Desk would know: how to ask your insurance company to cover an out-of-network doctor (something we Marfs have to do a lot, particularly for surgery) and what the appeals process is if the insurance company says no.

Off Your Desk is offering Musings of a Marfan Mom readers the chance to be the first to get your questions answered! Just leave a comment (or comments) here with your questions by Jan. 27th. If you’d like to remain anonymous change your name but leave your valid email so that they can contact you if they need more information to answer your question. From your questions, they will choose at least one to spotlight.

Also, if you sign up for the Ongoing Support Plan by Jan. 27th, Off Your Desk will give you the first month for free! Just make sure to mention this blog when you register.

I can’t wait to see what kinds of questions get asked! I’m sure I will learn a lot in reading the answers.

Below, check out Off Your Desk’s 6 Quick Tips to Tackle your Health Insurance Paperwork Effectively in the New Year.

1. Clean up your 2010 claims
Don’t lose out on reimbursements due to untimely filing which is extremely common. For most health insurance policies, you have a maximum of 6 months after a procedure or doctor’s visit to submit a claim (can be up to 12 months for out-of-network claims) – and sometimes these “timely filing limits” can be much shorter. Make sure you understand the limits imposed by your policy – and submit those 2010 claims so you don’t lose out!
2. “Use or lose” your 2010 FSA by April
We don’t want you to lose out on hard earned FSA savings. If you have a Flexible Spending Account (“FSA”) or Health Savings Account (HSA), your account may have limits on how long you have to use these funds to reimburse 2010 expenses. In many cases documentation such as carrier Explanations of Benefits (“EOBs”) or pharmacy receipts are needed to utilize the funds. In the case of the FSA, if you don’t utilize the funds before April, you’ll lose them entirely.
3. Learn Your New Policy
It’s worth it to take the time to acquaint yourself with your policy for 2011 on your carrier’s website. Even if you haven’t changed policies, the details of your plan’s benefits and requirements can change year-to-year. Pay special attention to basic requirements like pre-certification (getting prior approval from the insurer) and referral (getting a referral from a qualified physician) requirements; insurers have been cracking down on these and frequently deny claims if the procedure is not appropriately pre-certified or the patient is not appropriately referred.
4. Confirm Your Pharmacy Benefits
Pharmacy co-pay schedules can change year to year, leading to major cost changes if you regularly take prescription medicine.  Check with your carrier to understand your pharmacy benefits; now may be a good time to discuss generic alternatives to your existing prescriptions with your physician, or to consider using less expensive mail-order options to save on the cost of monthly drugs.
5. Consider Annual Check-Ups
Many people are not aware that their insurance policies fully cover annual wellness check-ups.  If it has been a while for you, check with your carrier to see if the visits are covered.
6. Verify Who Your In-Network Lab Provider Is
It is sadly not unusual for consumers to find out too late who their in-network laboratory provider is.  Best to confirm this before your family encounters 2011’s first lab tests.

* All opinions expressed in this post are my own. I was not compensated for this post beyond the opportunities for my readers to receive some questions answered.

Be Sociable, Share!

Related Post

3 Comments

  1. Can you help a little girl with autism get feeding therapy? She’s been denied multiple times and given a different reason each time.

    Here’s a little more about her. http://www.tinyurl.com/sarahs-fight

    [Reply]

  2. Do you answer questions about Rx drug plans? For example, if I need drug A, and instead of having, for example, a $10 co-pay for it, my Rx plan makes me pay 30% of the price, am I paying 30% of the total retail price or some other arbitrary price they’ve worked out with the drug co.? If you pay a percentage of the retail price instead of a set co-pay for a 30 day supply or a 90 day supply or whatever, does that mean some people will end up paying more than other people based on how much of the drug they take? If one person needs a higher dose of the drug than another person, will they pay more because the retail price would be more and they have to pay a percentage of it?

    Does this question even make sense!? Ha!

    Just one of those nagging questions I’ve had that I’ve never bothered to look into. Thanks!

    [Reply]

  3. I don’t know if I’m allowed to ask a question, but this is a scenario I see a lot. Marfan syndrome is a disorder that, when it comes to surgeries, really necessitates someone who is very familiar with how our bodies heal. Say a person needs a surgery, for their eyes or to have aortic valve sparing, but their insurance company doesn’t cover any of the specialists. The family puts in a request to have the insurance company cover the specialist and the insurance company denies that request on the basis that there are surgeons in-network who can perform the surgery (ignoring the fact that none of the surgeons have experience with Marfan patients, whose connective tissue is very different from the average person’s). How can people figure out where to go to appeal the insurance company’s decision? Does every state have such a place (I know CA does)? And is the answer to this question any different if the patient is using private insurance as opposed to a child on a state funded insurance program?

    [Reply]

Leave a Reply

Required fields are marked *.