Ibs-qveen - Chronic Illness

Introduction

Hello! If you've found your way to this blog, congratulations! Or condolences, if the circumstances that brought you here suck. Either way, welcome!

I am someone who works in the health insurance field (and will be remaining anonymous due to my obligations to my employer), so I've got some insider tricks. Not only that, I have multiple chronic conditions which means I've dealt with insurance from both ends.

The purpose of this blog is to help people (Americans, mostly) understand health insurance, how it works, and how to make it work for you.

All this to say, I see a lot of bullshit in my day to day life. I watch people pay more than they should or not receive the care they need because of a lack of understanding and knowledge.

I want to change that, one person at a time.

Below the cut are important posts and resources for basic information. Always feel free to write an ask if you don't see your question answered or want more detail.

**Disclaimer: No information on this blog is legal or medical advice. This is meant to be a resource for common questions or problems people run into. All information on this blog is generalized, and may not apply to your health insurance policy. This is based solely on my experience and is not binding information. The information here does not reflect the opinions or policies reflected by my employer. Always consult a medical professional for health questions, your insurance policy for benefit/claims questions, or a lawyer for legal advice.**

Basic Terminology

Types of Insurance Plans

Calling Your Insurance

So you want to make a doctor appointment...

Preventative vs Routine Services

Investigate Your Providers

Medical Malpractice/Lawsuits

What the &$#* is a claim?

My claim got denied...now what?

How to Pay Your Bill

Collections Agencies and Credit Scores

Medical Binder

HIPAA Part One

Resources:

United States Preventative Services Task Force

Healthcare.gov Preventative Services

i have no words

source

Before you pay that not-covered hospital bill:

I want to take a min to spread awareness for the No Surprises Act after noticing a reddit post earlier.

This protection for patients just popped up in the past couple years, and the one major downside is that it's up to the patients to speak up to make use of it, but not everyone knows what it is.

"If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit."

Consumer fact sheet

Typically, health insurance companies will help pay for bills from "in-network" providers, AKA their VIP inner circle gang turf. They won't help pay if you get medical care from another gang's henchmen (out of network).

This means that sometimes, a person would go to the hospital, which they knew had been covered by their insurance before, so they expect it's going to be relatively affordable. But they didn't know that multiple medical "gangs" were working in the same hospital. Their anesthesiologist, for example, was from a different gang. That specialist was out of network even though the surgeon and nurses were all in network.

Boom. Big bill for thousands of dollars and their insurance refuses to help pay it.

But now we have this law! The No Surprises Act means that insurance companies need to cover "surprise" expenses (under certain conditions).

If you don't have health insurance, hospitals and clinics need to give you an accurate quote before you get services, then foot the bill if they were too far off the mark.

The Fact Sheet section of the Centers for Medicare and Medicaid services have some wonderful user-friendly resources for you about health insurance and how this act works.

Keep in mind that Medicare and government-run programs always have weird rules for everything, so you might have different (yet similar) protections through those programs.

If you have a medical bill that wasn't covered by insurance and you think it might count as a surprise bill, please check out your rights and consider fighting it instead of letting it become a stressful expense or debt you can't repay.

Go here to start figuring things out for your situation:

Health insurance companies have way, waaaaay too much power over our lives. We need every drop of protection we can get - but it only counts as much as we can understand and use those protections!

Do people know about Vocational Rehab? If you're USAmerican they have this in every state.

It's a program that helps disabled folks access education, training, and employment. For FREE.

You only have to be disabled to qualify (autism, ADHD, mental illness, physical illness, etc) and they cover very broad categories of disability. You do NOT have to be officially diagnosed yet when you walk in - they will even help pay for your diagnosis if you are struggling w disability.

I applied with my suspected autism and fibromyalgia, and they paid for 100% of my formal autism assessment.

Once your disability is established they will give you career counseling to learn about your interests and skills, and depending on the plan you create with your caseworker they will then help with school or finding employment. They paid for 100% of my college tuition and books, and even provided a laptop for me to use.

You do not have to pay anything for this program. If you make above a certain income, you will have to contribute to educational costs but will still receive assistance.

They will also help with the cost of things like mental health counseling while you work towards your goals, clothing for interviews, etc.

They cannot discriminate based on your race, gender, or sexual orientation.

They won't make you do excessive meetings.

They will allow you to do meetings with your caseworker remotely.

They will not drug test you.

They want you to succeed.

I'm sure that individual experiences vary but my caseworker was exceptionally easy to work with and very kind.

Vocational Rehab is a phenomenal resource every disabled person should be aware of. Here is the list of offices in every state:

Thyroid Awareness Month! Waking up and feeling like a normal human being is always a gift that is never taken for granted.

Some people don’t want to hear this but sometimes accessibility is not sustainable or eco-friendly. Disabled people sometimes need straws, or pre-made meals in plastic containers, or single-use items. Just because you can work with your foods in their least processed and packaged form doesn’t mean everyone else can.

doctors offices are always like BE ON TIME IF YOU'RE MORE THAN FIVE MINUTES LATE WE'LL EXILE YOU TO MARS meanwhile you get there on time and wait a minimum of 20 minutes

𝐏𝐈𝐍𝐍𝐄𝐃

𝐚𝐛𝐨𝐮𝐭 𝐦𝐞 : lexi / 24 / gad & ibs

𝐛𝐥𝐨𝐠 𝐭𝐨𝐩𝐢𝐜𝐬 : chronic illness / disability / invisible disability / gut health / mental illness / advocacy

hey guys psa regarding hospital bills

don’t just pay it. do not automatically pay the hospital bill when you receive it. call your health insurance provider and POLITELY say, “excuse me, i just received a bill for $1200 for my hospital visit/ER visit/etc., is that the correct amount i’m supposed to pay?” because hospitals bill you before your health insurance and they will take your money no matter how the amount due may change based on your health insurance looking at it. 90% of the time, if your health insurance is in any way involved in the payment of that bill, you do not have to pay as much as the hospital is billing you for. call your health insurance provider first, and POLITELY request clarification, always remember that the person you are talking to is human and this is just their job, and then you will very likely find out you actually only owe $500.

don’t shout at anyone about it, don’t get mad, just understand that this is The Way Things Are right now and call your health insurance provider before paying the bill your hospital just sent you. there’s a chance the hospital bill might be correct, true, but call your health insurance provider.