Day 9: Knowing the Process of Referrals and Authorization- Second of 5 Posts on Being Your Child’s Advocate

31 Letters to the New Mom of a Child with Spina Bifida

Day 9: Knowing the Process of Referrals and Authorization- Second of 5 Posts on Being Your Child’s Advocate

This day 9 in my 31 day blogging challenge on my daughter's Spina Bifida diagnosis.  I hope the information in these posts is helpful to someone.

Dear Momma,

As your child’s advocate, you must understand the process for medical referrals and authorization.  Every state and insurance company will be different in some aspects so the best thing you can do is find out how it all will work for your child.  Trust me, driving 4 ½ hours with a baby to have a CT scan done and finding out when you get there that the insurance will not cover it is no fun.  Save yourself the aggravation and keep reading.   Below are 5 things you can do to ensure your child is receiving the proper care at appropriate times:

1.       Contact your insurance agent, find out what medical procedures need to have prior authorization and which procedures, equipment and appointments do not.  Let them know what procedures your child might need over the next year and find out the procedures for requesting insurance payment of them.  Record all this info and place in your child’s medical binder.

2.       Ask your child’s Primary Physician, how the referral process works and who is in charge of authorizations and referrals in their office. GET ON A FIRST NAME BASIS with the person in charge of that process and make sure you have their contact info in the medical binder.

3.       Follow-up with everyone until the procedure has been completed or the equipment has been received.  Be persistent, follow-up with your child’s primary physician, the medical specialist involved (neurosurgeon, physical therapist, etc…), the insurance company, the equipment vendor and the authorization specialist in your child’s physician’s office.

4.       Don’t back down, if there is a specialist, doctor or agent that is not completing their paperwork in a timely manner…stay on them-be a “squeaky wheel” until they get with the program.  If they aren’t getting any better about it, find someone else (supervisor or new doctor).  Your child’s health and well-being are more important than loyalty to someone that is not doing their job!

5.       Rinse and Repeat.  Every medical procedure will require attention before you ever get to the doctor’s office and insurance policies get updated or changed  so be prepared to repeat steps 1-4 frequently.

With Love,

Sherry

P.S. Don’t forget to have all records from any appointment, procedure or evaluation sent directly to your home address or ask for copies before you leave the office.