From the Desk Of… Tamika Chambers
2020 – March:
From the Desk Of…
Tamika Chambers, CCS Financial Navigator
Human error happens all the time. We know that. But it can seem to occur frequently within the context of medical billing and coding, and when it does, knowing the appropriate questions to ask insurance providers is key. Just consider this example from a few months ago, when a local cancer survivor became the first client to utilize Cancer Care Services’ new Financial Navigation program.
Like many others, this client’s medical expenses had piled up quickly, creating too much of a burden to juggle single-handedly. We sat down together and, after some work, devised a comprehensive path to get him/her over the top and on the other side of this mountain of financial stress. Together, we labored through more than 200 medical claims. Among them, we identified 67 denied claims that we thought warranted a closer look.
Over the course of two weeks and countless calls to insurance representatives, we worked to understand the client’s insurance company’s Explanation of Benefits statements. I asked why each claim was processed in the manner it was, and I shared the answers with the client, to give him/her a clearer understanding of his/her insurance coverage.
During this extensive evaluation period, we discovered one $1,000 claim that had been denied as “not medically necessary”. But in fact, an identical claim had been processed – and paid – weeks later by the same insurance company. Investigation into the initial, denied claim revealed that it had simply been coded incorrectly and was, after all, a covered benefit under the client’s policy. The claim was reprocessed and the client’s bill was adjusted accordingly.
In addition to reviewing current insurance claims, the financial navigation process dealt with older medical debt that had already been sent to collections, too. Debt validation letters were sent (to verify the details of what is owed) and, as a variety of disputed debts were resolved, the client’s FICO score improved. What’s more: two medical debts tallying greater than $800 were wiped clean!
Currently, work continues to reduce his/her residual debt, creating the opportunity for him/her to look toward and begin the next phase of our plan: saving for the future. This is a huge victory for our client!
An improved credit score, deletion of two medical debts and getting a claim reprocessed by him/her insurance carrier represent so much more than an umbrella, giving him/her shelter from the down pour of financial toxicity, it’s more like the sun has come out on a brighter day. Together, we weathered the storm.