Vent!! Why do families think nurses know all about insurance coverage?

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Specializes in Correctional, QA, Geriatrics.

I just had to vent. I have basically wasted several hours over the past few weeks with a guardian who demands I research her childs Medicare Part D plan to find ways to get over the counter and vitamins covered, to find a way to "work the system" to get a tiered drug co pay reduced but not change the drug and to basically find ways to circumvent the rules so she does not have any out of pocket expenses for the childs mile long grocery list of meds and vitamins.

My patient population all receive services through a Medicaid funded waiver and therefore qualify for Medicare Part D drug benefits also. These plans vary considerably about which drugs are on which tier but they all exclude vitamins except for prenatals and fluoride supplements. This mother has a masters degree but tells me she can't read the evidence of coverage or formulary and comprehend it. She insists nurses know "all about insurance stuff". Really? I guess I missed that class. Because everything I have learned has been since I began my real world career and I had to seek it out just like everyone else.

I am not seeking solutions. I just had to vent because I have had a lot of these conversations over the years in various forms and it still blows me away that the general public honestly believes "nurses know all about insurance coverage". In addition I personally am all for saving money but to quibble over paying $20 to $30 a month for vitamins and co pays for someone who takes 9 prescription meds and 5 vitamins and OTC antihistamines irks me. To me that seems like an awesome bargain. I wish my prescription plan covered that many items for the same amount of money.

OK, all better now lol. I just had to get that off my chest.

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Specializes in Utilization Management.

That is so very irritating when patients assume you have every insurance company and their individual benefits memorized. I work with insurance companies daily and I still have to consult a reference guide. Put the mother in touch with a social worker.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

A very rude employee of a doctor's office asked to speak to the nurse of one of my patients last year, then hung up on me when I (the nurse) was unable to provide any of his insurance information.

The general public has only a very truncated notion of what nurses do on a daily basis, so we somewhat become the default person for everything. If they need help with their insurance companies, tell the nurse. If their remote control batteries are dead, tell the nurse. If dietary sent them some cold scrambled eggs, tell the nurse...

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I know you just wanted to vent but....

Doesn't your place have social workers/ patient advocates etc. etc.?

Also, I will say that for some people $20 - $30 bucks a month in co-pays can be a crippling expense. One assumes they are on medicaid for a reason, n'est pas?

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Specializes in Critical Care.

I've worked in the medical field for almost 10 years. To this day, it cracks me up when a patient tells me, "Why are you collecting $75 for my visit? My deductible is only $10."

I don't know how you can confuse a $1,000 deductible with a $10 co-pay, but it happens more often than not.

I have my BS in Health Care Administration, but I can tell you the only reason why I know anything about insurances is from working at a medical office.

I don't know how people can expect a nurse to know about insurance information, when there are so many different types and everyone's coverage is different.

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A very rude employee of a doctor's office asked to speak to the nurse of one of my patients last year, then hung up on me when I (the nurse) was unable to provide any of his insurance information.

The general public has only a very truncated notion of what nurses do on a daily basis, so we somewhat become the default person for everything. If they need help with their insurance companies, tell the nurse. If their remote control batteries are dead, tell the nurse. If dietary sent them some cold scrambled eggs, tell the nurse...

That is why we are called the patient's advocate. We may not know the details of cold scrambled eggs but we know where to go to find out. ;)

We are the default person, especially about insurance info. Just find out how to find out and tell the patient.

I usually call a particular person in billing. Or give them the phone number.

steph

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Specializes in Acute Care Psych, DNP Student.

My BSN program's core curriculum includes a US Healthcare Policy and Healthcare Financing class. I just received the textbook. It's over 1000 pages of policy, politics, and healthcare financing methods (including types of coverage). Of course the implications of how to navigate the system and get maximum coverage for patients is included. However, I'm thinking this is applicable for case managers, mostly. What staff nurse has the time to delve into an insurance policy and come up with creative problem-solving solutions?

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My BSN program's core curriculum includes a US Healthcare Policy and Healthcare Financing class. I just received the textbook. It's over 1000 pages of policy, politics, and healthcare financing methods (including types of coverage). Of course the implications of how to navigate the system and get maximum coverage for patients is included. However, I'm thinking this is applicable for case managers, mostly. What staff nurse has the time to delve into an insurance policy and come up with creative problem-solving solutions?

True . ... .but we could point them in the right direction. ;)

My next class in my RN to BSN program is "Nursing Econ". Lots of political info in that too. One of my friends who is already finished with this program did her paper on "Universal Health Care".

My take on what the instructors want from BSN grads is to get more politically involved.

steph

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Specializes in LTC, assisted living, med-surg, psych.
My BSN program's core curriculum includes a US Healthcare Policy and Healthcare Financing class. I just received the textbook. It's over 1000 pages of policy, politics, and healthcare financing methods (including types of coverage). Of course the implications of how to navigate the system and get maximum coverage for patients is included.

If you can't think of even one good reason for single-payer health care, there it is.:angryfire

'Nuff said. Back to our regularly scheduled thread.

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Specializes in Acute Care Psych, DNP Student.
If you can't think of even one good reason for single-payer health care, there it is.:angryfire

'Nuff said. Back to our regularly scheduled thread.

You are such a delight. :heartbeat

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Specializes in Acute Care Psych, DNP Student.
True . ... .but we could point them in the right direction. ;)

My next class in my RN to BSN program is "Nursing Econ". Lots of political info in that too. One of my friends who is already finished with this program did her paper on "Universal Health Care".

My take on what the instructors want from BSN grads is to get more politically involved.

steph

Yes, it would be beneficial to point the patient in the right direction. I think this sort of class should be required in all RN programs. I guess I was expressing my frustration between what I call the lecture class v. real world split. We learn all these fantastic and wonderful things in lecture; I think it's a marvelous education.

Then we show up in clinical and see that there's rarely time to use a lot of what we've learned: the nurses are running around from task to task while trying to catch their breaths. Of course this doesn't mean we shouldn't learn anything any differently than we are - it's just a bit frustrating.

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Yes, it would be beneficial to point the patient in the right direction. I think this sort of class should be required in all RN programs. I guess I was expressing my frustration between what I call the lecture class v. real world split. We learn all these fantastic and wonderful things in lecture; I think it's a marvelous education.

Then we show up in clinical and see that there's rarely time to use a lot of what we've learned: the nurses are running around from task to task while trying to catch their breaths.

To be fair I must admit I'm in a different program - since I'm already a nurse, we saw very little clinical time. Lots and lots of APA papers. :eek:

steph

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