Is it Okay to Change Oncologists?

The short answer;  ABSOLUTELY!

A cancer diagnosis hits patients and loved ones like a brick. Most often you are unfamiliar with the ins and outs of the diagnosis, especially initially.  Cancer management is time-sensitive and you may feel rushed to make life-altering decisions while trying to cope with the emotional aspects and everything else.  You likely at some point have felt a degree of depression, anxiety, and a feeling of uncertainty. Hopefully, you or your loved one have started-off the path of managing the diagnosis with an oncologist and team that you feel comfortable with and have the utmost trust for. 

However, sometimes further into the process, things change and patients and loved ones often feel “stuck.” Just like in any relationship, people’s demeanor, personality, and trust level can change. As a patient, you should feel comfortable getting a second opinion at ANY point of your care. I have seen several patients not seek a second opinion, because they felt inadequately competent in the field and didn’t want to “overstep”.  Remember this is YOUR life.   You should always feel welcome to ask questions and feel comfortable with the plan and care that you receive. Each person has a different experience.  You may have received a great referral from a friend about an oncologist, but your experience was very different. And that is ok!

In my opinion, a good oncologist (or any healthcare provider), should encourage, or at the very least be okay with a patient getting a second opinion. Of course, medicine is a business, but the first priority should ALWAYS  be the quality of life, health, and success of the patient; not an oncologist’s reputation or monetary gain.  

I once had a very reputable oncologist tell a client and myself that he “ is only willing to be the captain of the ship and nothing else”.  This was in regard to requesting if he would be willing to assist in managing care locally, for my client who was currently part of an out-of-state clinical trail.  Definitely NOT the answer my client was looking for.

As a patient, it is very important that you feel confident in your choice of oncologist.  And if that changes, a second opinion is almost always an available option. You may have a second opinion that is exactly the same as your current treatment. In that case, it may help confirm that your current management plan is appropriate for you.  Or it may be the same treatment, but you feel more comfortable asking questions to a new provider, etc.

Don’t be afraid to obtain that second opinion.  Pathway Patient Advocates is here to help you navigate through it all.  Contact us (248) 247-8552.

Do you have a Medical Bill?

Has your insurance company ever denied any of your claims? Have you received bills stating you’re responsible for the full cost of services rendered? Have you ever been told after receiving care, imaging, or lab work that it is not covered because the services were not necessary?

Most of us have encountered rejected medical claims. Many times, we may not know why or how a claim was rejected, but we pay anyway because we got a bill. The good news is, you do not always have to pay! After finding out why your claim was rejected, you always have a chance to appeal the rejection in hopes that the insurance company overturns their decision. This may result in them paying the claim so that you are not stuck with the bill!

Pathway Patient Advocates assists with medical bill appeals

Insurance companies only know what information they receive from the billing provider. For instance, let’s say you were having chest pain and went into an urgent care center. The urgent care does a workup including a physical exam, labs, chest x-ray, and an EKG. They end up diagnosing you with the common cold. The urgent care submits a claim to your insurance company reflecting which tests were done and what the final diagnosis was. Weeks later, you receive notice from your insurance company that you are responsible for the EKG because it was not medically necessary. Of course, this was necessary due to the chest pain you were experiencing. But to the insurance, why would you need an EKG completed is you just had a common cold? You may simply file an appeal to have the insurance company reverse the denial and pay for the services in full.  

Sounds simple, right? Sometimes it is, while others are a little more difficult. Every insurance company has a different appeal process, and it is important to understand what each company requires. Many of them are confusing and require extensive documentation. Call us today if you need help filing an appeal with your insurance company!

Pathway Patient Advocates (248) 247-8552

What is a Medical Profile Summary and WHY should YOU have one?

Pathway Patient Advocates Medical Profile Summary

2020 has taught us the importance of preparing for the unexpected.
Think of it this way: You wouldn’t leave the house without a driver’s license, so why would you risk encountering an emergency without having a Medical Profile.  Let me explain more:

So what is a Medical Profile Summary?

A medical profile summary is an up-do-date organized summary that includes your pertinent medical history, contacts, and medical wishes. It is typically 1-3 pages long.  Once this is created it can be easily updated as things change.

Why is a Medical Profile Summary important?

It is important because if you are in an emergency situation, the healthcare professionals will quickly have pertinent information that they need to help care for you best. Another place it comes in handy is when going to see a new doctor or another healthcare provider. It is a great idea to give a copy of your Medical Profile Summary to a family member or friend in case of an emergency. 

What do you do with a Medical Profile Summary?

A good place for a Medical Profile Summary is in your purse/or wallet and somewhere easily accessible in your home. As mentioned, it is also a good idea to give a copy to a  family member or friend.

Doesn’t your doctor already have all this information?

Maybe.  In today’s healthcare industry, patients often see various providers at various health care facilities, hospitals, urgent care facilities, outpatient surgery centers, etc.  While technology has improved how many of these communicate and share information about joint patients; there is often information that is missed as well as a very large amount of information in an unorganized arrangement. Also not all healthcare professionals such as EMS (ambulance) have access to this information. A Medical Profile Summary is a concise brief pertinent summary. The goal is to have you as the patient be up to date on your medical profile as well as provide a more efficient way for health care providers to care for you. 

How do you obtain a Medical Profile Summary?

Pathway Patient Advocates can help.  We can create a medical Profile Summary for you as well as provide it in a format that you can easily update as needed.  Contact us to learn more.  (248) 247-8552.

HMO, PPO, ACO, PCMH, FSA, HSA… What do these all mean???

pathway patient advocates
pathway patient advocates

Most of us think that insurance coverage is confusing enough, well throwing in some more abbreviations does not make it any clearer.  These abbreviations have been around for a while, yet many of us really have no idea what they stand for, what they entail, and which ones they currently are a part of. Open enrollment will be here before we know it, so here is a brief breakdown on what these abbreviations actually mean:

HMO

Stands for Health Maintenance Organization.

If you belong to an HMO, then you are limited to receiving care from providers in that specific network.  HMO’s also put an emphasis on primary care, making the primary care provider a form of gate-keeper, requiring referrals. 

PPO

Stands for Preferred Provider Organization. 

If you belong to a PPO plan then you have the option to receive care from providers that are outside of the “preferred network,” but likely will have a higher deductible. Also, referrals are typically not needed.

FSA (flexible spending accounts) and HSA (health savings accounts) are consumer-driven plans that allow you to have more control over how you spend your money on health care.

PCMH

Stands for Patient-Centered Medical Home. 

A practice must meet certain standards to become a patient-centered medical home. This often involves bundled payments, where a fixed amount is paid per month.  One goal of PCMH is to promote more efficient care. 

ACO

Stands for Accountable Care Organization. 

This is an organization that includes, not only a primary care practice but hospital and specialty care as well.  The goal is to improve coordination by working together to provide high-quality care.

So, which plans should you have, or do you have?  Well, it depends on several factors such as your age, current health, living situation, and much more. 

We can help clarify it all. Contact us today.  [email protected]

Premiums. Deductibles. Co-insurances. Co-Payments. Out of pocket maximum.

What do all these things mean? Medical billing can be so complicated, and it is important to understand these terms when selecting an insurance policy and paying outstanding medical bills. Here is a breakdown of common billing terms you will encounter.

Premium: This is the amount that you, your employer, or both combined, pay monthly for your insurance plan.

Deductible: This is the amount you must pay yourself before your insurance begins to pay for services.

Co-insurance: This is a percentage of a service amount that you are responsible for.

Co-payment: This is a set amount that the patient is responsible for at each office visit.

Out of pocket max: This is the maximum amount that you are required to pay for the duration of your plan.

Pathway Patient Adovcates can help with medical bills

It is imperative that you can recognize the difference between these terms. Some common questions individuals have when they review bills from their healthcare providers are:

“Why am I getting a bill if I already met my deductible?” Meeting your deductible does not mean that you will not owe any more for the remainder of your plan. This could be attributed to multiple things such as your co-pays and co-insurance.

“I paid my co-pay when I was at my visit. Why am I getting another statement?” Most of the time, co-pays are not all you owe for office visits. If you have not met your deductible yet, you may be receiving a statement for the full amount of the office visit. If you have met your deductible, and paid your co-pay at your office visit, you may be getting a statement for 30% of the bill, which would be reflective of your co-insurance.

“This plan has an out of pocket max of $50,000. Will I have to pay that full amount if I choose this policy?” In short, NO! You may not ever reach your out of pocket maximum. The amount you pay throughout the year, aside from your premium, varies on how often you utilize healthcare services Many factors play a role in healthcare expenses annually, but an out of pocket max is not a required payment amount.

If you are struggling to choose the right insurance plan or understand your incoming bills, we can help! Give us a call to make sure you are selecting the plan that is right for you and your needs or to make sure you are not overpaying for your medical bills.

Cancer During COVID19

WHAT YOU NEED TO KNOW

Life during the COVID pandemic is filling us with uncertainty and fear.  If you or a family member are diagnosed with Cancer or are a Cancer survivor, you likely have even more questions during this time. Today we address some common questions that you may have:

Am I at an increased risk of contracting COVID19  if I have Cancer?

Anyone that is exposed to the COVID19 virus has an increased risk of contracting the virus.  Having cancer does not increase your risk of contracting the virus, however it does typically increase the risk of experiencing a serious illness if COVID is contracted. There is also a possibility that immunocompromised (which often includes cancer patients) patients are infected with the virus for a longer period of time.  Each day, we learn more about the virus.  The CDC website  https://www.cdc.gov/coronavirus/  is a great website for updated information.

Am I less likely to survive through COVID19 if I contract it?

Patients with Cancer are considered to be higher-risk of becoming severely ill if they are infected with COVID.  This is because a cancer patient’s immune system is often weakened by cancer or cancer treatment, such as immunotherapy.  Of course, each and every patient is different.  If you had cancer treatment in the past, you may have a normal immune system now.  If you are unsure about what precautions you should take, it is a great idea to contact your oncologist to obtain his or her recommendations.   

What about my family members?

Family members, especially ones living with you, should take extra precautions against contracting COVID, to help avoid spreading the virus to a cancer patient. 

What can I do if I am having difficulty gaining access to proper Cancer Care during this COVID Pandemic?

Hand turns a dice and changes the expression “Questions no Answers” to “Questions and Answers”.

TImely cancer care is essential to support appropriate quality of life and help provide the best possible treatment outcomes.  If you are having difficulty gaining appropriate access to care,  we can help.  Pathway Patient Advocates specialize in cancer navigation. We can assist with navigating all aspects of your cancer diagnosis.  Call or email us anytime.  https://pathwaypa.com/contact/

Have you Considered a Clinical Trial?

Perhaps you or a loved one just got diagnosed with the dreaded “C” word.  Or perhaps you have been battling cancer and the treatment it is just not working or not tolerable.  There are lots of possible options and it is your right to know about them to see which option may be best for you, and this includes a clinical trial.

What exactly is a Clinical Trial?

A clinical trial is a medical research that involves people. There are 4 different phases of clinical trials. Now the big question… Why would participating in a research benefit you?  Well, because it allows you to have access to medications or devices that are not yet available by all healthcare providers to prescribe (not yet FDA approved).  Said another way, it makes medication or treatment available to you that is not yet on the market. That is because it is still in the testing phase.  That may sound scary, and I’m guessing that the next question that pops into your head is, is it safe?  Clinical Trials in the US require that stringent guidelines be followed prior to being approved.  Also, very detailed qualification measures are set in place to ensure that the patient’s who are participating meet the appropriate criteria.  Frequent monitoring is also enforced.  These guidelines are set in place to allow the safest possible environment.  In most cases, a patient is able to drop-out of the study at any time.  Also, each trial is different.  That is why it is so very important to understand the trial very clearly before making a decision.  There are hundreds of thousands of clinical trials worldwide.  Careful consideration is necessary when considering a clinical trial.  Appropriate questions should be asked to see how you (or a loved one) could benefit from the clinical trial.

How do I pay for it?

Several insurance companies, including Medicaid and Medicare, will cover clinical trials. However, it can be very cumbersome obtaining proof of this approval to the proper facility running the clinical trial.  If you don’t have insurance or your insurance does not cover the clinical trial, there is often other assistance available.  Don’t dismiss a clinical trial because you have been told it is not covered.  This happens ALL TOO OFTEN, and most times that is incorrect. Please talk to a patient advocate first.     

Is it Worth it?

There are several scenarios where a clinical trial is a success and a patient’s life is prolonged, sustains a better quality of life, or even goes into remission.  Yes, amazing outcomes can be achieved… and that is the ultimate goal!   Of course with a clinical trial, there are no guarantees that the trial will provide successful results.  That is why it is important to thoroughly review your clinical trial options prior to applying for one.  

Why can’t I just ask my doctor?

While talking to your physician is a good idea, physicians are not always aware of the extent of clinical trials available and the methods of dealing with the often hurdles to qualify for them.

Where do I start?

Pathway Patient Advocates is here to help; putting the focus on your quality of life goals and offering you a better understanding of how clinical trials work. We will help guide you through the process of reviewing clinical trials, as well as the qualification process.  The diagnosis of cancer is burdensome enough, let us help you ease your journey. Talk to us: http://www.PathwayPA.com

Are You Paying Too Much for Your Healthcare?

None of us are strangers to receiving a bill after a physician’s office visit, a procedure, or hospital admission, and thinking “WOAH, there is no way this is right”.

Medical billing errors are common, and unfortunately, many people are overpaying for healthcare services. Some errors are a result of miscoding, while others are attributed to the untimely filing, and sometimes even duplicate billing.

Improper coding: Insurance companies may reject a claim because the level of service or procedure code may not be justified by a diagnosis code. So many of us have been victims of this. I recently received a hospital bill after a trip to the emergency room. My symptoms needed to be addressed urgently, and the ER was my only option due to the time of day. I spent about 1 hour in the hospital and did not receive any medications, imaging, or procedures. Soon after my visit, I received a hospital bill for over $1,500! After reviewing the denial from my insurance company and further researching the claim, I recognized that the hospital billed for an incorrect and uncovered diagnosis. Months of a dispute later, I owe the hospital $0. Can you imagine if I paid the original bill without looking into it? It is important to understand what you are being billed for and why to ensure that you are not overpaying for your medical bills. 

Timely filing: After an office visit or procedure, healthcare facilities have a limited amount of time to submit a claim to your insurance company. Many times, they may neglect to submit the claim in time for various reasons, and your insurance company may deny the bill. This results in the patient receiving a bill for the full amount of the claim. If this happens, the full bill is not your responsibility. Communicate with your insurance company to ensure the claim was received on time, and coordinate with the hospital to have the bill revised for the appropriate amount.

Duplicate billing: Have you ever received a bill and thought to yourself, “I am sure I already paid this”? But, because you received another statement, you pay it anyway. Nowadays, so many statements are computer generated and sent on a monthly basis. There may be a lag in posting a payment, so a patient receives a bill for a service that was already paid for. It is important to keep track of all payments made and investigate if you are unsure of what you are paying for, or certain that you have already made the payment. 

If you need assistance understanding a medical bill or disputing a bill to a facility or insurance company, Pathway Patient Advocates can help! Our experience in billing and coding will help ensure that you are not overpaying for any of your healthcare services.

What is a Patient Advocate and why do I need one?

The healthcare system is pretty confusing to everyone.  A patient advocate is here to help with that.  A patient advocate can help you understand and

What can a Patient Advocate actually do for me?

Bills:  Approximately 80% of medical bills contain errors.  You may be receiving bills or even collection notices.  You may even be reluctant to get the medical care you need due to concerns about cost.  Here’s where we can help: We can assist with appeals, Health Plan benefit education, correcting billing errors due to improper coding, as well as complete medical billing review and audits.  Our billing and medical expertise can save you money and leave you feeling comfortable to get the medical care you need.

Navigating a new or chronic medical diagnosis: Being sick is scary. Especially one that is life-altering such as cancer. We want you to know that multiple options are available and Pathway Patient Advocates can assist you in navigating your path to management and comfort.

Pediatric Navigation: Do you have a child who has been diagnosed with a significant acute illness or chronic disease? If so, you are likely feeling overwhelmed (as if being a parent isn’t overwhelming enough), scared and alone. For many, having a sick child is more emotionally exhausting than being sick themsevles. A patient advocate is here for and your family to help you navigate the process. This includes resources such as coordination of care, second opinions, researching different treatment options, etc. You don’t have to travel the path alone.

International Care: Are you from another country? Is English not your primary language? Do you need help transferring international care? Do you need assistance with choosing the best health care plan? A Patient Advocate is here to ease your transition into the American culture.

Senior Care Placement: As we age or develop different medical issues; we become less independent. Loss of dependence, whether minor or complete can be a difficult adjustment. There are many factors involved in choosing the best placement and care for yourself or a loved one. A Patient Advocate help make that transition smooth and enjoyable.

These are just a few ways a patient advocate can help.

Many hospitals offer a complimentary Patient Advocate, why would I hire a private one?

While many hospitals do now offer patient’s a patient advocate, they are more like customer service representatives.  The patient advocate may refer you to the billing department or other areas in the hospital.  They typically do not themselves have a medical or billing background.

A private patient advocate provides an experienced medical professional with unbiased suggestions and assistance to help navigate your path to the best possible care.

My insurance does not cover a Patient Advocate, why pay for the extra expense?…

To start, you only have 1 life, so we recommend that you care for it well. Think about all the things purchased in your life.  All the tangible luxuries and amazing experiences.  With a healthy life, you have the opportunity to start or continue enjoying life; it is essential to take care of your health.     

Why choose Pathway Patient Advocates?

The Pathway Patient Advocates Team includes both medical and billing experts. Our span of knowledge is equipped to assist you in any challenge of medicine that you face. Most important is our passion and dedication to helping you succeed and overcome these barriers. Our professional and personal experiences with challenges in healthcare have led us to develop Pathway Patient Advocates so that we can help people like.

Contact us at Pathway Patient Advocates anytime.  We are here to help. https://pathwaypa.com/contact/

When Your Child is Sick…

Being a parent is an absolutely amazing experience, but it is also exhausting and brings a lot of responsibility.  From the second your child is born, you, as a parent are now responsible to protect this tiny human in every aspect of life. When your child becomes sick, as a parent you often feel helpless. Even if it a common cold or small scratch; it is hard to see your child in pain or uncomfortable. 

You feel especially helpless if your child develops a medical condition that you feel is undiagnosed or improperly treated. Too many of us have had experiences where you take your child to see a pediatrician or to an urgent care and are told something similar to “nothing is wrong, it’s common for parents to overreact.”  While this is true, it is often NOT the case.  Parents are often, blown-off far to easy.  If you have a gut feeling that something is wrong with your child or something is not being properly addressed..trust your motherly (or fatherly) instinct! And if your wrong…it is 100% okay.

A good healthcare provider who has your child’s best interest will not be offended by a parent asking more questions or wanting another opinion.  If you do experience this, then maybe its time to find a new healthcare provider. A trusting relationship with your child’s pediatrician or other healthcare provider is essential.  You are trusting this professional’s advise in areas you are less educated in.  Their response to your child’s symptoms and general wellbeing is detrimental.  But remember it is YOUR child.  You have to feel comfortable with how this provider is managing your child’s care. 

While it is easy to do, try not to feel embarrassed asking questions if something doesn’t make since.  You are your child’s advocate and they need you.

If you find yourself struggling for undiagnosed symptoms or a sense of uncertainty, then what do you do?  Do not feel alone. Like the saying goes…It takes a village.

Pathway Patient Advocates can help.  We understand your struggle and will help you in your path to finding a provider that best aligns with your comfort level. One that you can build a trusting relationship with. We can help you find second opinions and feel settled about your decisions.  We are here for you and your family. Together, we got this!