Insurance, Financial, and Legal Issues

Depending on how your loved one is feeling, she may be able to handle paperwork and phone calls associated with work, finances, insurance, and legal issues. But she may need help and you may find yourself helping more and more with these important matters as time goes on. It’s wise to begin to familiarize yourself with them. Your Woman to Woman volunteer, hospital social worker, and other trained staff should be able to help guide you through the process of organizing paperwork, applying for government assistance, and dealing with legal documents and the insurance company.

The first step will be determining what her insurance company covers, or if she is uninsured, determining eligibility for group policies through professional or retired groups, such as teachers’ unions or professional industry organizations, or Medicaid.

How you can help:

  • Make sure that she stays up-to-date on insurance premiums to avoid a lapse in coverage. Find out if pre-authorizations will be needed for any test or procedure to avoid unexpected costs.
  • Connect with the case manager assigned by the insurer. These individuals provide a link between the insurer and the healthcare system and can help streamline the processing of claims.
  • Be prepared to file a grievance if a claim is denied. The process for appealing a denial should be spelled out in your policy. Make sure all receipts and insurance communications are saved as a matter of course.

Medical Bills Not Covered by Insurance and Out-of-Pocket Expenses

Extra medical expenses and other necessary costs, including childcare, transportation, and medical equipment, can pose an additional financial burden and impact her psychological well-being at a time when she is coping with the physical challenges of treatment.

How you can help:

  • Make sure all receipts are saved, as some may be tax-deductible.
  • Find out about local resources that can help with additional expenses, such as churches and other charities.
  • Offer to organize bills and reach out to other relatives and friends for financial help, if the need arises.
  • If finances are limited, offer to talk to the hospital social worker or financial counselor about working out a plan for payment. And encourage the patient to seek debt consolidation or counseling, if needed.

It’s not easy to discuss issues like making or changing a will and/or healthcare directives, but these are important topics to address during a health crisis. Advance directives, a living will, and a healthcare proxy (also known as a durable power of attorney), allow patients to determine what kind of medical interventions they will get if they are not able to communicate their wishes or make decisions. You can help by asking the hospital social worker what legal issues need to be addressed.

Work may be financially necessary during treatment. Many doctors encourage it as a welcome distraction and a way for the patient to return to a comforting, predictable routine. However, if the doctor advises the patient not to return to work, you can help her look into the following programs.

Family Medical Leave Act (FMLA)

This federal law provides job and benefit protection to employees, as well as their caregiving spouses. It applies to employees at companies with at least 50 people. Although the law does not provide for the employee’s salary, it ensures that a patient’s job—or that of a spouse who is caring for her—will still be there following treatment.

Short-term Disability

Short-term disability is private insurance provided by many employers that replaces a percentage — typically 50-75% — of a person’s salary if they are unable to work due to illness. It typically pays a portion of the patient’s wages between the time sick leave is exhausted and long-term disability begins. The hospital social worker can help you gather the paperwork needed to apply for the benefit.

Long-term Disability

Provided by Social Security, long-term disability bene ts go to people with a medical condition that is expected to last for at least a year or to end in death. Benefits are based on an individual’s age at the time they become too ill to work and the amount of time they worked under Social Security. It’s advisable to contact Social Security as soon as possible to determine the patient’s eligibility and to apply for benefits, as it can take several months for a claim to be processed. Call 1-800-772-1213 to make an appointment at your local Social Security office or visit www.ssa.gov.

How you can help:

  • As difficult as it can be to discuss the end of life, it’s important to let your loved one express her wishes. Consider becoming her health care proxy to make sure her wishes are known.
  • Be sure that copies of her advanced directive (or living will) get into the hands of other family members and healthcare providers.