Linda Brandwin, R.N. Linda Brandwin is a registered nurse and a medical billing and claims specialist. For the past 10 years she has worked directly with insurance companies to give advice and guidance to the health care consumer. Readers may send email or write Linda Brandwin at 5500 Single Oak Hill Ct., Woodbridge, VA 22192.

Insurance handbook can sometimes be an enlightening tool
Oct 1, 2004

Q: I emailed you two years ago with this advice and still you fail to pass it on in your column. Why is the patient, in your eyes, never responsible?

Insurance companies supply their customers with handbooks or websites. It is the responsibility of the insured to open their handbook and familiarize themselves with the list of hospitals and providers that their insurance company has contracts with.

Please, why don't you ever mention the patient's own insurance handbook? There are too many people that refuse to take responsibility for their own insurance decisions and then want to blame someone else. It is evident that you foster this way of thinking. I wish you would consider this tip and enlighten your readers.

A: I agree that the insurance handbook can be an enlightening tool and that it can be a valuable resource for information. Patients should look in their handbook for answers to their medical insurance problems. I always advise people never to assume anything, and they do have to take responsibility for their bills and insurance claims.

However, a patient should not be responsible for health care providers' mistakes or insurance company errors. These answers are not in a handbook. Another problem with the insurance handbooks is that they are not always up to date. Often they do not have current lists of health care providers who are contracted with them or those whose contracts have not been renewed. Coverage and rates change constantly and sometimes the patients do not receive this information either.

One of the biggest problems with the insurance company handbooks is the medical and insurance language used in them is just too difficult to decipher. And besides using unfamiliar terminology, often the rhetoric is vague and not specific enough to get a concrete answer to patients' questions.

So, yes, the handbook sometimes can be a good tool. Yes, the patient is sometimes responsible for some of the issues they encounter. But there is no way a patient can anticipate, prepare, and avoid all medical insurance problems. Processing a medical claim involves too many people and procedures which automatically makes the medical insurance system vulnerable to errors. As a patient advocate, I try to go beyond the insurance handbook to find answers and solutions to patients' medical billing questions.

Follow Up Response from reader: I disagree. I see provider handbooks daily. The first few pages list the in-network hospitals clearly. They are cut and dry so a layperson can see the list of hospitals they should go to. The list is upfront and not hidden.

Follow Up Answer: The handbook lists are not always current. Doctors and hospitals are always being added or subtracted and that information is simply not published and given to the patients. Just because a doctor's name is on the provider list of the handbook does not mean that he is a provider. He could have dropped out of the insurance program and a new list was not printed and sent to the patients. This happens all of the time. I have found that you can not count on the information being accurate and updated in a timely fashion.

Also, many patients just sometimes need to talk to people. They simply need that interaction to understand what is going on. It is easy for people in the medical field to understand the insurance information…it is what we deal with daily. But so many people just don't understand it. Medical issues can be very confusing and complicated for the layperson. Reading a handbook will never be adequate for them. They need to hear and confirm the answers with a real person, not an automated voice or a handbook.