Calling A Health Advocate

As part of my health coverage through my job, I have access to a toll-free health advocate line. If I have questions about my insurance coverage or an explanation of benefits I can give the number a call. On the other end of the line are advocates that specialize in explaining my health plan's benefits in plain English. Best of all, this service is included in my benefits package at no extra charge!

Facing an insurance dilemma

I got back a price I didn’t expect when getting a new spacer. I reviewed the online tools for pricing and I went back and forth a bit with the specialty pharmacy on the phone. I didn’t get how they were arriving at that price.

So who did I call? Nope, not Ghostbusters! I flipped over the back of my insurance card to find the number and gave the health advocate line a call.

A few rings and I’m connected to a pleasant advocate who verifies my insurance details. She looks up the specific claim I had a concern about and explains how it should be covered. Patiently, she went over it line by line to make sure I understood what my plan would cover.

The advocate then proceeds to start a 3-way call conferencing in the pharmacy. She and the pharmacy representative go over the details of my claim. In this conference call, we are finally able to get to the bottom of my question about how my insurance works for spacer devices.

Utilizing a health advocate as a resource

I’m glad I took the time to call the advocate line and get a real understanding of this particular issue. At first, I felt a little silly. It was a small claim and I’m a college-educated person. Surely I can understand simple health insurance coverage?!

Yes, given enough time banging my head at it I could’ve figured it out. However, there is no shame in asking for help! These professional advocates read these kinds of documents day in and day out. They know what they are looking for in the insurance statements.

Asking for help when I need it

This was an important moment for me to ask for and accept help. Often I feel like I need to know everything to be a “good” asthma patient. Which couldn’t be farther from the truth! Knowing when to ask questions and being willing to ask those questions makes me a “good” patient. I am compliant with medications and have well-controlled asthma.

Yet, I feel like a failure when there is something about asthma I don’t know. I shouldn’t feel this way; I'm not a professional. Yes, I could take the time to learn how to decipher health insurance benefits, but I'm a patient advocate, not a professional advocate. There is no replacing my own lived experiences with asthma. However, those lived experiences don't inform how my insurer processes claims.

Oh, and guess what? Even if I did figure out how it works, insurance will likely be different the following year. Next time the online price tool confuses me I’ll give the health advocate service line a call without guilt.

Have you used a similar service offered through your health benefits provider? I'd love to hear about your experience in the comments below.