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!

Telemedicine

Telemedicine: What is it and why is it important to understand during this time?

Healthcare organizations are doing all they can to limit the number of patients coming in and out of their facilities, but many of these patients still need consultations and follow up care. In order to navigate around this, many organizations are moving toward a modern way of practicing…telemedicine. During the COVID-19 crisis, telemedicine is becoming a standard in healthcare. By utilizing advanced technology, patients are still able to receive adequate care during this difficult and uncertain time. Telemedicine visits range from telephone calls to e-mail threads to video visits.

Telephone encounters: Nobody is a stranger to calling their doctor’s office with questions or concerns, but did you know that your doctor may be able to conduct an office visit by phone? Much routine and follow up care can be relayed to a patient with a simple telephone call. Practices are using this method to relay important directives to their patients on what to do regarding abnormal imaging, test results, or prescription refills. Most of the time, this method of telemedicine is used for patients who are already established in their physician’s practice. 

E-mails/patient portal: Most major healthcare organizations have their own patient portals that they utilize to release test results, set up appointments, and communicate with their patients virtually. You may be able to submit a communication via your physician’s portal with symptoms you may be experiencing or results you may need a further or more simplified explanation on. By using this electronic method of communication, your physician can reply to your inquiry virtually and it will be documented in your electronic medical record.

Video visits: There is nothing than can replace the face to face interaction that one receives from their physician during an in-person office visit. This holds especially true in specialty practices, and for visits in which you have not yet met your physician. Video visits are the next best thing. By utilizing video visits, your physician can conduct a live appointment via skype, facetime, or other video chat methods. You can see your physician on camera, read their body language, and ask questions in which you receive immediate feedback.

At Pathway Patient Advocates, we use all methods of e-visits to care for our clients. If you need our assistance during this pandemic, please reach out to us to set up a free virtual consultation. 

Cancer and COVID

Cancer and COVID: How are life-threatening diagnoses being handled during the COVID-19 pandemic?

Cancellations. Restrictions. Office Closures.

All these things have reached an all-time high as our country battles the Coronavirus pandemic. Now is a time, more than ever, to fear getting a diagnosis that requires further workup, surgery, etc. The surgeon general has canceled all elective procedures. Hospitals have implemented restrictions on imaging and testing that can be completed. Specialty offices are closing, while their staff is being redeployed to the front lines. These are just a few of the hurdles that healthcare organizations and patients must jump over during this time. So, how are life-threatening diseases, such as cancer, being handled?

A suspicion of cancer requires imaging, lab work, and ancillary testing be done to reach a proper diagnosis. With all the current limitations, many patients are unable to obtain these necessary tests so that their physicians can appropriately diagnose them and determine treatment. Cancer treatment options include: chemotherapy, radiation, and surgery. Surgeons are restricted and cannot operate on all their patients, while chemotherapy infusion centers are limiting the number of patients in their facilities. With all these restrictions in place, physicians are required to evaluate their patients to determine what the best treatment option will be. Can a patient’s condition wait a couple months to be re-evaluated? Is chemotherapy or radiation an option if surgery cannot be completed? These are the questions physicians are asking themselves when deciding which treatment plan to pursue during this time.

Physicians are doing all they can to best care for their patients. Safety is everyone’s priority. Times are scary. It is extremely important to understand all your options and coordinate with your physician to determine which treatment is right for you.

If you or a loved one has been diagnosed with cancer, or any other life-threatening disease, call us at 248-247-8552 to set up a consultation. We will discuss treatment options to help you determine your correct path to better health. 

International Barriers

I can relate from personal experience, the difficulties getting accustomed to new a new atmosphere, new culture and just trying to stay afloat in a new life.

The US healthcare system is challenging enough for native American speakers, add any language barrier and it becomes almost impossible to understand. 

My parents migrated to the US just before I was born. They picked up their family of 6 and made the journey from Italy because of a job opportunity that my father received.  It was an opportunity to provide a better life for his family.  Now, several years later; they are grateful that they took that leap.  However, our family faced several struggles through the process as we adapted to our new life.

A few weeks after her arrival to Michigan, my mother started feeling sick, with some unusual symptoms.  She was just beginning to learn English and still did not have an established doctor. Without any opportunity for research, a recent acquaintance provided her with a number of a nearby doctor.  Her appointment ended with the doctor informing my mother that she had a large tumor in her uterus.  After about 2 months of various prescribed medications, her symptoms continued to worsen and the doctor informed her that the tumor was cancerous and continuing to grow.  He insisted that she have an urgent total hysterectomy performed. 

Of course, to a couple with 4 young children, who had just moved to a foreign new country-this was a lot to take in. Feeling that they had not had much of a choice, they trusted the doctor and proceeded with his recommendations. 

During the surgery, after her doctor’s scalpel opened up the uterus; to his surprise instead of a tumor-there was a baby sitting in there-nestled right next to an IUD.  The uterus was sutured and planned surgery aborted.

In recovery, my mother was informed of the news. Of course, she was relieved to find out she did not have cancer but shocked that she was pregnant, misdiagnosed and improperly treated. At the time, her doctor informed her that the fetus would unlikely develop to a full-term viable pregnancy.  My mother decided to take the risk, and a few months later she gave birth to a very little, but healthy baby girl.  And that is the LONG version of how I entered this world. 

While thankfully I was born healthy, I also suffered years and years of medical issues that could have potentially been prevented with better care.

While that was several years ago, I can tell you that despite the amazing advancements in medicine-similar errors like that happen today and I have witnessed them all too frequently. 

A language barrier or unfamiliarity with the US healthcare system, should not be a reason to result in improper medical care.

I see it all the time, where patients feel embarrassed or inadequate to ask health care professionals questions, because of a language or cultural barrier. Confusion and unfamiliarity with terms and processes lead to people being uninformed and also creates a lack of trust towards the health care system.  Once a lack of trust is present…It is so difficult to fix.

Right now, with so much necessary focus being targeted towrard the Coronavirus (or COVID19), access to adequate care has become even more challenging.

We can help…

Pathway Patient Advocates can walk with you and help you interpret medical bills, understand your various options for medical insurance coverage and provide you with available options of health care providers.  You will have the ability to make informed decisions for the care of yourself or your loved ones.

COVID19 ESSENTIALS

By now you are probably very familiar with the word COVID19. And have heard various different opinions and may be confused as to what to believe.

Here are some basics of what you need to know. If you have an underlying medical problem such as cancer, diabetes or are immunocompromised and need direction on who to contact or what to do; contact us and we can help you navigate to the information and providers that you need. By now you are probably very familiar with the word COVID19. And have heard various different opinions and may be confused as to what to believe.

WHAT IS COVID19:     The coronaviruses are a group of viruses.  There are many different strains.

In December 2019, a new strain of Coronavirus was identified in China.  The corona virus was thought to be contracted by a person from an animal while at a live animal market in Wuhu, China.  Since then, it has rapidly spread. The coronavirus quickly became known as COVID19. In March of this year, the Word Health Organization characterized COVID19 a national pandemic.  It is spreading rapidly and has affected people in all 50 US states and at least 166 countries. 

Many Names:             Some now refer to COVID19 as the Chinese virus. So whether you hear Corona virus, COVID19 or Chinese virus, it is all referring to the same virus.

How is it Spread:        The virus was thought to be spread by respiratory droplets; which means it is spread from person to person by, droplets that are not seen by the human eye. The virus spreads in the air from one person to another. The droplet can get in the mouth or nose of individuals and further spread throughout the body.  What’s more, the virus can live on different services for different lengths of time.  

However, most recent research has supported the virus to be airborne-meaning it can be spread just by breathing in contaminated air (not requiring droplet contact). This update is important because it calls for more stringent measures to prevent spread.

The exact length of time the virus lives on various surfaces is not exactly known; but it is suspected that the virus can live on surfaces such as steel, plastic, and glass from 3 or more days.

Resources:                  A lot about this VIRUS is still a mystery, but every day we learn more. The following websites are great up-to-date information about the virus:


The primary goal of healthcare is to appropriately focus all efforts toward defeating this horrible virus.

This inevitably leaves many patients with other medical issues unaddressed. If you have a medical issue that you are having difficulty getting addressed to delayed access secondary to the focus on the COVID19 pandemic; we are here to help you navigate the appropriate path. Contact Pathway Patient Advocates: (248) 247-8552.