Webcast
KMCO Archives
Understanding,
Accessing, and Appealing Your Benefits
(Originally
broadcast on March 22, 2000)
Hello
everyone. We're really happy that you're with us today. This
is Faye Eldar from the University of Illinois School of Public
Health. I'm the family coordinator for the Quality Community
Managed Care Project, and today we're doing a program about
understanding, accessing and appealing your health insurance
benefits. Our speakers today are two people who are really
knowledgeable in this field, and we're really happy that they've
agreed to share their expertise with us. The first speaker
will be Barbara Melman. Barbara is the owner of Claim Relief,
a company in Chicago that specializes in helping people deal
with health insurance claims, denials and appeals and she
is also a columnist for the Chicago Sun Times. The second
speaker will be Cheryl Carter. Cheryl is a parent of two children,
a five-year-old son and a two-year-old daughter. She lives
in a suburb of Chicago. Cheryl's daughter is profoundly deaf
and she had a Cochlear implant last year, and she is going
to share her experience as a consumer in accessing insurance
appealing and dealing with denials in relation to services
for her daughter.
Q.
Barbara, could you tell us a little bit about Claim Relief,
what you do and what your area of expertise is?
A.
What we do is we literally lift the problem of people having
to deal with their medical insurance issues We take over the
handling of this. Through the column, I also am constantly answering
letters and questions from people that are having terrible problems
in dealing withinsurance and denials. I've been doing Claim
Relief, for 16 years and I've had the column for four years.
So I think I've seen just about every kind of problem that anyone
could ever have.
Q. What
do you think is the most important thing that a consumer needs
to do in order to be able to understand their insurance benefits?
A.
When they first get the plan, they have to go over the information
given to them, whether it's a booklet or however it's given
to them. If they have a special issue or a special need for
themselves or someone in their family, they need to write any
questions and get right back to the company to find out exactly
what it is in their situation they may need to know.
Q.
Sheryl, would you say that before you had your daughter you
had a good understanding of your health insurance benefits?
A.
Let's say I thought that I did, but I did not. I was not one
to sit down and read the book. The first time I really opened
the book was just when we got it to make sureour doctors were
in the plan. But I really did not know wha tI needed to know
about the plan until my daughter was diagnosed. Then I read
the book. I made copies of actually the what's covered and what's
not covered and carried it around with me to different doctors
and such so I could refer to it.
Q.
And Barbara, what kind of written information should people
get about the health plan and where can they get the information
from?
A.
Well they need to know what kind of certifications they need,
what the customer service number is,keep their card handy all
the tim and be aware of how the planworks. I think that's the
most the first important thing todo is know what kind of a plan
you have and then, of course,know what benefits are available
under that plan. But you need to know if it's an HMO, a point
of service, a PPO,exactly how does my plan work.
Q.
Okay and people get a brochure from their insurance company
or they get it from their employer about the insurance and they
don't understand it, what do you recommend that they do?
A.
Well, I recommend that they call. First I would try the customer
service department of the company and hopefully. In many cases,
you can get somebody who is knowledgeable of the plan that will
tell you some of the basic concepts of the plan, again how it
works, what they need to do in order to get their claims paid.
Again, if you're looking at a certain provision in a plan that's
iffy, it's going to be much more difficult than just finding
out generally how your plan works. If you think something should
be covered under the plan have it
submitted and then take it from there. Don't make yourself sick
over thinking something's not going to be paid. Make sure it's
submitted and submitted correctly. Find out for the provider
exactly what is needed to get that claim in for the specific
item or treatment and then wait until it is process. Then, like
I say, from there, start working on any reviews that are necessary.
Q.
Okay. Now what about people who are in managed care plans where
they typically don't have claim forms to fill out?
A.
But you need referrals. And if you need a referral, and I stress
this all the time to my clients and in the column, if you need
a referral, keep copies yourself. Don't just trust that the
primary care physician will send it on to the referring provider.
You take control of that so that if necessary, you've got it
in your hand if they tell you that that's one of the reasons
that they are not paying the claims.
Q.
Sheryl, what has been helpful to you in learning about what
exactly the benefits were in the health plan and how you and
your family were able to understand what the benefits were as
related to your daughter's needs.
A.
Well basically just by going through it. Unfortunately, we didn't
really know of anyone who had been through this so really didn't
know where to turn. So what we did is submitted our claim to
the insurance company. They denied us. We read the book a little
further, talked to the doctor, talked to the surgeon. And then
asked for people we could get in touch with who have been maybe
been through this, what they would suggest, different things
that they had done and avenues they had taken to understand
their insurance a little bit better. We also we called the insurance
plan. We also called the person who manages the insurance plan
who oversees the whole insurance plan and who can basically
make the decisions of changing the insurance plan and wrote
him letters as well.
Q.
Could you tell us a little bit about the story about your daughter
and how the decision was made for her to have the Cochlear implant?
And if this was something you and your husband decided or a
doctor in your health plan recommended this. Just fill us in
a little bit on the background of you know from the beginning.
A.
Okay. Well she was diagnosed for the first time at nine months
old and the second opinion was at ten months old. At the suggestion
of our doctor that we went for the second opinion. I was just
a little bit happier there. The first time I
was told my daughter will never hear. She will never speak like
a normal person. She will never go to a normal school and I
just felt that my whole world was falling apart and how do I
handle this? And so I called up my pediatrician and said where
do I go from here and he said give me a couple days. I'll find
someone for you. We'll send you to five people if we need to.
And that's when we found our second place that we went to which
really just has a great team and they really have done a lot
of directing for us. I put a lot of trust and confidence in
them. What they recommended that we would do is put Skye in
hearing aids for five months just to see if she would could
get any kind of response out of her with hearing aids and make
any progress that way. We followed her direction, did the home
therapy and we could not get any kind of a response with Skye
and hearing aids. Nothing. We would ring a cow bell behind her
and nothing. Drop a pan, scream loud, truck horn, nothing would
make this little girl turn her head or speak or anything. So
we, at that point, were told by her therapist, if you want her
to have a chance at spoken language and a chance to be main-streamed,
we're not promising you anything, but this is the only avenue
right now available to give you that chance. We figured what
what do we have to lose? This is our only chance and we felt
that we were really with a good team who had been directing
us very well to that point. And so that was basically how we
made our decision was that we had no other way to go. This was
the only way to keep going forward.
Q.
Did you have any problems with the insurance coverage related
to this type of treatment?
A.
Well, we did we did have problems with the insurance coverage
even before we decided to go with the Cochlear Implant. Most
insurance plans do not pay for hearing aids. So we understood
that we didn't I don't believe we even tried to get them paid
for because the hospital lent them to us. Maybe they knew somehow
that we were going to go with the implant. I'm not sure but
they just were very kind and lent them to us for the five months.
But her therapy that we went to every week came out of our pocket
and we tried sending in letters and submitting it to the insurance
company and they would not pay for any type of therapy. They
said it was like schooling and schooling should be paid by the
parents. So to that point, and at that point, I wasn't ready
to dive myself in I guess into all of this. I was more geared
towards trying to find out about implants and what roads we
were going on and what did we really want to do this and you
know what I mean? There were a lot of different things that
I guess I wanted to look into, so I didn't really spend a lot
of time on appealing the therapy at that point. But when we
did decide to go with the implants, we sent a letter of recommendation
from our surgeon to the insurance and it was denied.
Q.
What kind of insurance plan do you have?
A.
We have it's called Preferred Plan, Inc. But ours is a little
bit different than a lot of insurance companies out there I
guess because it's a private insurance. So basically we don't,
from what I understand, have really a lot that we can do even
with even if we retained a lawyer because this is more of a
private insurance. What it states in the book really is what
they will do for you and nothing they don't need to do anything
above and beyond.
Q.
Okay and Cheryl this is insurance that you have through your
employment?
A.
Right, through my husband's employment.
Q.
Do you have one insurance plan or two?
A.
We have one insurance plan. They denied us for the implants
immediately. It was probably a week later, I believe it said
that an artificial ear is not an artificial limb and they only
cover artificial limbs or prosthesis or arm, leg, something
like that. I just I couldn't go for that. So we tried appealing.
They came back and this time they said that it's not medically
necessary. She could live a normal life without hearing which
again I couldn't go for. So this is when I said okay we really
have to try and get tough here, dive ourselves into it. So we
contacted our surgeon again and asked her to write a letter.
We had her audiologist write a letter. We had her therapist
write a letter, the pediatrician, and a friend. We each wrote
a letter, myself and my husband. I contacted the State Board
of Insurance. I called state representatives. I wrote them letters.
Q.
You did it all.
A.
I did it all. I had an uncle who actually worked on a private
insurance investigation practice. I had him look into it read
the book, write a letter. I called the the doctor and I said
do you have anyone who has been through this? Do you have any
parents you
can put me in touch with and I asked the therapists and other
people the same thing. and I asked to be put on mailing lists
and eventually through that I started to get contacts of people
and what they had done. And so I saw some success stories out
there and I said darn it, we can do this too. And unfortunately,
we were denied for the third time, even after doing all of this.
Advanced Bionics, which issues the device, had wrote them a
letter. The woman had called the head of the insurance and offered
to fly out. She had an hour conversation on the phone with him.
The end of the conversation she told him do you know that I
am profoundly deaf and I'm talking to you right now with an
implant? And he got quiet and said I'm sorry. We still need
to deny it. So we weren't sure how far we can push. So we decided
to go after I said again a lot of praying and talking and deciding,
we said one more time. One more time we're going to try and
if that doesn't work, our backup is a fund raiser. We're just
going to do a big fund raiser and that that's what will do it
hopefully. And the fourth appeal was done by Advanced Bionics,
the company again who issued her Cochlear implants. They wrote
just a wonderful letter. I wrote another letter.
Q.
What do you think they said differently that time than the other
time?
A.
I don't I know that they put something in there about the act
for children with special needs. I know that there is some type
of act. Barbara, you might be a little more familiar with that.
Q.
Do you mean the Americans With Disabilities Act?
A.
Yes. They put something about that in there and they called
the insurance and asked if they wanted to discuss this a little
further and the head of the insurance again he said well are
they going to sue me? And she said I really don't think they
want to take it this far and, of course, we didn't because again
we were in fear for my husband's job. So they said how about
we ask for another outside medical opinion So they had another
outside doctor review it. He came back and said it was medically
necessary. But the final decision was still with the company,
even though this outside doctor said it was medically necessary.
I think that really helped us. They said that they needed one
more day. They told Advanced Bionics they needed one more day
to just get their decision together. They had made their decision
and, of course, I am just suffering that day thinking well,
of course, it's no. If they have to think for a day, they have
to write down all their reasons why they can't because they
are thinking we may go ahead and pursue legal action. The next
day, Advanced Bionics called me and the lady was screaming on
the phone. This is the insurance coordinator and she says I
have the the appeal in my hand and it is approved. She said
that's right, this is the approval and I get goose bumps right
now. I fell to my knees. I sobbed I thanked God I just I it
just was so much emotion that i felt and it was a week before
Christmas.
Q. Now
how long did you actually fight the whole situation?
A.
This was a four month process.
Q.
Sheryl, you have done a phenomenal job. I can only imagine that
you probably worked on this day and night for four months and
did very little else.
A.
I did.
Q.
What recommendations would you have for other families regardless
of what their child's need is but for having some needed service
denied by the insurance? What advice would you give them?
A.
I would first say to be persistent. If you get that denial letter,
don't just file it away and say well they denied us. Appeal
and if they deny you again, reappeal and then go through the
avenues I did. Contact doctors the therapists that you might
be going to. Ask them to get you on mailing lists and contact
with other families. Keep asking them. There's a wealth of information
on the internet and I actually found a support group on the
internet that is an around the world support group for children
with hearing impairments, but I am sure they have things like
that for other special need children.
Q.
You know I'm really glad that you brought that up because part
of our Website where this broadcast is posted also is a resource
list and we will be putting up information about this work that
you're involved in and many resources for families who have
children with all kinds of different special health care needs.
A.
And it is very helpful to have that. I found this Website halfway
into my appeal process and I really wish that I had found it
much sooner than that because there are a lot of people who
have been through the insurance ups and downs and just on a
more personal level even outside of the insurance, just having
somebody who's been through the same thing that you've been
through. I would say definitely search the internet and with
the search, it is so easy. You just type in this need and a
lot of things will come up.
Q.
Well I thank you for your advice and I think that would be really
helpful to many families and parents out there. Barbara, can
you tell us a little bit of people that you work with like what
percent are involved with denials and what percent are other
kinds of insurance problems?
A.
Well of course it all depends on the diagnosis and I think that
one of the things you want to do when you're dealing with a
difficult situation like Cheryl's was is to not just deal with
the person that answers the phone. But go above that person
within the company and touch base with one manager if you can
and stay with that person. Let them get to know you understand
your situation. I think what Sheryl did was absolutely incredible
and wonderful and hope just listening to you, Sheryl, was so
wonderful to me because I see people going through these kind
of things. And I feel like sometimes some days at the end of
the day, all I have done is fight for people that have claims
that should be processed and have not been.
Q.
Barbara, something else that I just thought of. When you talk
about going above the person who answers the telephone and finding
a manager to work with, a lot of people report that every time
they call the insurance company, there's a different person
for them to talk to and when they ask if they could have just
one person to call, they're told well no that's not possible.
So could you go through some basic steps to find a contact person
within the insurance company?
A.
I think if it's just a regular claim situation that you
want to know why something was paid the way it was or if there
was a mistake, they're going to tell you that you just need
to speak with whoever is on the line. But if it's a situation
that you've already put in a review and the review was denied
and you're putting in another review, you just have to let people
know. It's kind of hard I know for just a person to try and
call up and say I need to speak to a manager. But the only thing
that I can tell you to do is just to just be persistent and
I know it is difficult and I know it can be difficult, but my
word is fight and be very nice but very firm.
Q.
And is it best to have these conversations over the telephone
or do people need to send letters or both?
A. I
would say definitely both. And whatever you are having your
provider send in for you, I would keep a file so that you do
know everything that's going on and everything that's been submitted
to the insurance companies. So when it's at the point where
you're dealing with getting the job done, you know exactly what
you're talking about. From the very beginning when you start
working with an insurance company, document the date, time and
person you're speaking with and just a little bit of what that
conversation was about. And if you have someone's name, they
can't tell you we don't have any record of that call. So you
have to be the one to keep those records.
Q.
So you think it might be a good idea for people to have a special
notebook where they right in everything?
A.
Definitely. Absolutely and like I say, put the date, the time,
the person and just a little bit of what that conversation was
about. And if you tell them that you need to speak to someone
in particular because of the situation, I think, one time I
I was arguing on the phone for like 15 minutes with a woman
and and she was just just being just so bullheaded and she wouldn't
listen to me and I knew she was wrong. And I just wouldn't let
up on her. And finally she became so frustrated, she said well
I'll pass you on to someone else. And I had said well I asked
you to do that a long time ago. So you just have to stay in
there because it's not easy. You're talking to people that are
almost reading scripts.
Q.
Let me ask you something else. In the health care field, we
often hear that some insurance companies have a policy of denying
every claim the first time it comes through. Is that true?
A.
No. I've never really seen that. I've certainly seen claims
denied on a daily basis that are incorrect. I have yet to take
on a new client and take in a lot of work and batches of work
and and go through everything and not find errors, but I think
in general, most claims do go through correctly. There's always
the few that do not, but every single claim does not get denied
in general most of the time.
Q.
Sheryl, did you find any errors in the the claims that were
related
to your daughter's surgery?
A.
I did.
Q.
How did you find the errors?
A. Well
fortunately, we, as I mentioned, were hooked up with a great
therapist so I would bring her my copies of denials and again,
like Barbara said, I have one of those books that has become
a huge probably five inch binder now and I have everything sectioned
off in date order and I would bring it to her and say this is
what I got in this week. And she looked at the coding for therapy
and she said this is the wrong coding. We need to resubmit under
a different code. So I understand that there can be some problems
with the coding.
Q.
Okay Barbara, could you please explain to us what exactly this
coding is?
A.
Well, there are different kinds of codes. There are procedure
codes which tell the insurance companies exactly what was done
if it's surgery or an office visit or an extended visit or whatever
it would be. And then there are diagnosis codes. And diagnosis
codes must match the procedure codes or somebody won't pay for
it.
Q.
Okay and where do these codes come from?
A.
Oh gosh there are well there's books. I don't have it in front
of me so I can't give an exact answer but there are people that
had that got together that did the coding it's like universal
coding.
Q.
Okay you're talking about the CPT codes?
A.
Right CPT right.
Q.
How would a consumer be able to know if the right codes are
on their claim?
A.
Well they won't and just like Cheryl said, it was by showing
it to an expert in the field. People that work for these billing
services they hopefully become billing experts. But
just
be aware that that could be one of the reasons that a claim
is improperly paid or denied. And it isn't even just a matter
of denial.
Q.
It could be a word processing error just like somebody spelling
your name wrong?
A.
Absolutely right. These numbers get put
in incorrectly
all the time. And so when you get a denial, it isn't always
the insurance company's fault. Just like Sheryl said, sometimes
many times it's the fault of the actual provider submitting
the claim and then the insurance company will deny it because
it's the wrong code.
Q.
Okay. Now Cheryl, I know you've worked very very very hard for
your daughter to have the surgery and treatment. Do you still
check all of the claims and all of the have the therapist all
the codes to make sure everything now is correct in addition?
A.
Well I know the code now so I just match up the last one and
make sure it is correct. But it took us sometime to get the
coding correct.
Q.
Are they paying for most of her therapy?
A.
They pay for none of her therapy.
Q.
None of her therapy?
A.
None. I looked at it that we really fought on this. We got the
insurance to pay for the surgery. They paid 90 percent of the
surgery. Fortunately, the other ten percent was written off
and it's between a 40 and 60 thousand dollar surgery. So at
that point, I was thrilled for that. We did try appealing the
insurance for the her auditory verbal therapy and for her meetings
with the audiologist which occur approximately every four to
six months as I mentioned earlier. So there is a lot that they
still don't pay for. We have continued to appeal for them. I'm
not letting down. I don't want to push them too hard. As I call
it, I like to be pleasantly pushy and I feel that I have learned
through all this how far I can push and I would like to maybe
readdress it a little bit harder in maybe six months or so just
to give them a little bit of time and I think I need to do a
little bit more research. I've done a lot of research though
and it looks as though we're not going to win this one unfortunately.
Q.
What do other parents tell you?
A.
I have well again my therapist who is very good with directing
us, has only two on her caseload that the insurance does not
pay for and I believe she has 18 or 20 on her caseload and there's
only two that the insurance will not pay. I get on to the support
group on the internet. A lot of people get their therapy paid
for and a lot don't. But you don't know each person individually
so you don't know how hard they are pushing and I know myself
I have really tried with this. And being that it is a private
insurance company, I don't know how much further we can go.
Q. Barbara, perhaps you can also talk about insurance plans
that not only is every in companies who write policies for health
insurance. But also every employer makes their own contract
with the insurance. So even if two people have the same health
insurance plan and they have different employers, their benefits
won't be the same. Can you tell us more about that?
A. Right,
well there's self-insured plans and then there's plans that
are issued through a state. And if a plan like Sheryl's is self-insured,
then they, as she said, run the plan
themselves
and can make the decisions. If a plan is issued through the
state and it could be a large company. In that case, it would
be the state that the plan is actually issued, not your own
state. Then you have the Department of Insurance of every state
to hopefully help back you up on some of these situations. And
what you do is you gather up all your information as well and
I would always first you do your reviews with the insurance
company. And after you've been denied and you feel that you're
just hitting a brick wall, you should gather all that information
and send it to the Department of Insurance and they step in
as an intermediary. And I have seen, it's kind of a mixed bag.
I've seen people win and I've seen people lose. But they do
make the insurance companies accountable for why they are denying
claims.
A. We
did write the State Board of Insurance also.
Q. And
they said they couldn't help you right because it was a self-insured
plan?
A.
Well they said that they couldn't help us with the therapy.
They did try and help us with the surgery itself and by the
time they got back to us, we were right in the middle of the
appeal process. I guess by the time actually they had gotten
in touch with the insurance company, the insurance company had
then done their approval. Maybe the insurance it could have
been a combination why they approved us. It could have been
because of the State Board of Insurance. The congressman that
we had wrote. I asked them to call. I asked them to write letters.
They sent me copies of letters.
A.
I also always do tell people to contact their state reps and
if necessary their U.S. reps to get answers on some of these
questions. We elect these people. They're there for us. And
I think we should be entitled to have them help us.
Q.
And what about for people who are in labor unions Could you
address that?
A.
Well again, unions are writing their own plans. So it it's like
if it's private industry writing the plan, you have to go to
the through the union to try and get them to change the determination
on the on the responses on the claims. Another thing I would
just like to bring up again what we were speaking about and
that was how to keep track of all of this. What I suggest and
what I've always done at Claim Relief is to get a chart and
make columns and do the provider, the date of service, the total
bill, the insurance company, if there's more than one company
and how much is out of pocket. And every time you get a copy
of a bill, put that bill on your chart and the date of service.
And once insurance pays, put how much they paid and how much
is out of pocket and that can be your determining factor. If
you have a limit on how much you have to pay your out-of-pocket,
you can keep track of it that way too for deductible and co-insurance
amounts.
Q. A
note to our audience. We will have a chart like this on the
resource section of the website that you will be able to download
and print it out to use at home. Now you get lots and lots of
paperwork from the insurance. How do you decide what you need
to keep and for how long you have to keep it?
A.
Well what I do is when I when I get the explanation of benefits,
I attach it to the bill. And you could have four or five copies
of one bill. And I only keep one that's itemized. And once it's
processed and paid by insurance, I staple them together. Before
they are completed, I clip them together. Once they are completed,
I staple them and then I know that that's a closed bill in my
file. So if things have a clip on them, they're still active.
If stapled, they're done.
Q.
And then how long do you need to keep all the the bills and
the claims?
A.
Well if it's a large claim and there's possibly something that
could come back again on running kind of bills, I'm thinking
chemotherapy and radiation therapy, those kind of things that
can go on and on and on, I would keep them probably a couple
of years just to be safe. And try and keep things in date order
and again if you can refer back to your chart, that will help
you very much in keeping track of all of this.
Q.
What do you do if you lose a copy of a bill or a claim or an
appeal?
A.
Well I would try and call and get new copies.
Q.
And who would you'd call the insurance company?
A.
Sure but now sometimes insurance companies say we cannot send
you another copy. You might want to check with the provider
if they got a payment and if it wasn't a bulk payment where
there was thousands of dollars for different people from the
company that came in, they might have a copy of the individual
explanation of benefits there for you.
Q.
Okay are there any times when you advise people that it's not
really a good idea to appeal something?
A.
The only time I I would and I don't like to because I think
anything should be fought, but if it's something truly cut and
dried in the plan written it is not covered. It's very very
hard. When it's vague, fight it. If it's not mentioned, fight
it. But if it specifically says this plan does not cover this,
it could be very difficult to fight something. It's all by the
written word I find and certainly I look for any loophole that
I can.
A.
I agree and that that is what gave us our chance is that it
said in our plan that they did not cover hearing aids and they
did not cover an ear as an artificial limb, but it didn't specifically
exclude a Cochlear implant.
A.
Exactly.
A.
So I said there is our opening. We can do this.
A.
Exactly. When you knew you couldn't fight for the hearing aid
because it specifically said it didn't cover that. But then
when she had the surgery, that was a whole other there was the
loophole. And you have to grab onto those loopholes and just
like the Carter family did not let go and just keep fighting.
A.
And I would like to say about that chart, I started one of those
charts last year and I would recommend that to anyone because
we just make a copy of that then for our tax person and all
I have to do is send that to her as well for any medical that
we can deduct on our taxes as well. So it's helpful not only
for us for keeping track of what's going on, but also for our
tax person.
Q.
Again for the audience, it's important to know that if there
are medical and disability related expenses for your child that
exceeds a certain percent of your income, I believe it's 7.5
percent and you have all the documentation that you're paying
for this out It's really important to keep track as you're keeping
track of all the insurance paperwork. And again when you go
to our resource section, we will have some more information
about that. Barbara, would you like to say anything about tax
deductions?
A. The
only thing I would like to say is be aware that even over-the-counter
items are tax deductible if they're medical.
Q.
In the work that I have done with families, I advise them that
the first time they do this, they get a letter from the
child's
doctor saying I am the doctor who is treating John Doe with
his birth date and Social Security number. His diagnosis is
and have the doctor list that and I have recommended the following
treatments for to the family for his condition. And send that
in with your tax return so the IRS will be aware of that.
A.
That's excellent.
A. Yes
we've kept track of different even types of toys that we have
had to get for her home therapy.
Q.
I would recommend that you get a note from the therapist that
they recommended these specific items.
A.
I was thinking the same thing.
Q.
Yes and the reason for them and attach your receipts to that.
They are not things that you otherwise would have purchased
for your daughter.
A.
Exactly.
Q. It's
also important for the families to know that your travel to
the medical and disability-related appointments can be deducted
if you keep records as well as your parking if you
get receipts.
And for a lot of families, there are some things that will never
be covered by insurance, even if you appeal and sometimes a
tax deduction is the only thing that's
available.
So it is really important to know about this. A. And when you're
reaching that that level of that 7.5 percent to start deducting,
then everything does become very important.
A.
Even the tolls.
A.
Yes.
Q.
I know what I do at home is I have a big envelope that I start
every January and I put all the receipts in there for medical
deductions because it's impossible to recreate this on April
14th. You have to do it consistently.
A.
Oh definitely.
Q.
Mark the mileage down on your calendar every time you go to
an appointment. I actually now I have a chart of all of the
different providers and what is the mileage to their offices.
A.
And as we said before, if you have a notebook, just automatically
like a diary, just put everything in there and then you can
always look right back into that book. You can even keep your
receipts in that book.
Q.
So I think we're getting close to the time when we have to close,
so I think we need to summarize about being persistent and Cheryl
has given us an excellent example of a very determined consumer
who is very methodical, very persistent, very determined who
was able to access care needed by her child and Barbara has
really given us a lot of practical advice from her many years
of working with consumers and helping them deal with insurance.
I would like to ask each of you if you have any things that
you'd like to share with the audience in closing about understanding,
accessing and appealing your benefits. Sheryl?
A.
I would say again to be persistent. Again as we talked about
you know how far you can go by reading your book, contact someone.
I wish I would have known of someone like Barbara to contact
and for help. Look through books. But try and find resources
every day. They are putting more and more resources out on the
web. There are a lot of places out there based on your income
that will help you. We've been very fortunate and have had some
places help with some assistance for us and again just be persistent,
write letters, read and take the time that you need. What you
put in is what you'll get out.
Q.
Barbara?
A.
I certainly agree and I think Cheryl's just a wonderful example
of how someone can be successful. Don't give up. If you feel
that there's a chance that that loophole is there, grab it and
most important as we said all the way back in the beginning
of this conversation, know your benefits. Be aware of what you
need to do, what your plan pays, how much is out of pocket,
and what you can expect and then just fight and call. Keep track
of everything and fight every day.
Q.
Okay well I want to thank you both very much for taking time
out of your busy schedules to share your expertise with us and
with other families who have children with special health care
needs. This is a very important topic and I'm very grateful
that you were able to give it so much attention and thank you
again.
A.
Thank you, Cheryl, good luck to you. You are wonderful and your
daughter's very lucky to have you.
A. Well
thank you. Thank you very much and I'm sure your clients
are very
lucky to have you and again I wish I would have known
there was
someone like that out there so I think this is great
that there
your name is going to be on this website and
hopefully
people will contact you for help who don't know what
avenues
to take who may not be as pleasantly pushy.
Q. Wonderful.
Thank you very much.
A. It was
wonderful doing this.
Q. Well
thanks to both of you.
End of interview.
