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.
