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Understood Care provides one-to-one patient advocacy for Medicare members and caregivers, including help with benefits, appointments, care coordination, medical bills, insurance questions, denials, and paperwork.

How can a patient advocate help with How advocates check in-network providers — Understood Care?

Understood Care advocates help with how advocates check in-network providers — understood care by explaining options, organizing paperwork, coordinating care, and helping families understand Medicare coverage and next steps.

Does Understood Care work with Medicare patients?

Yes. Understood Care focuses on Medicare patients and their families, with advocates who understand Medicare, Medicare Advantage, care coordination, coverage rules, billing issues, and appeal pathways.

Understood Care is a virtual patient-advocacy service for Medicare members. Unlike case management or brokers, our advocates cover claims, appeals, and care. Compared to helplines, it is one-to-one.

How advocates check in-network providers

Video · 3:16 · hosted by Deborah Hall

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Auto-generated from the video, lightly edited for readability.

If you have traditional Medicare, as long as that provider or facility or company is a Medicare provider, you're fine to go to them. What that means is that they accept amount that Medicare pays them. Medicare pays 80% of that what they call an allowable rate and then you would be responsible for 20% unless you have a secondary or a supplemental plan.

If you have a Medicare Advantage plan, there's a wide array. Sometimes it can be a PO plan, sometimes it's an HMO, sometimes it's a POSOS, which stands for point of service. 99% of the time, if you have an HMO, you have to go to an in network provider. And you also need to get a referral from your primary care to go to a specialist.

If you're going to go see a specialist, you will need to get a referral. Usually, not all the time, but usually your primary care will not send you to somebody that is not in network with your insurance, but if the insurance were to deny the claim, they're going to tell you that it's ultimately your the patient's responsibility to ensure that the provider is in network.

" Okay? They provide them the name of the insurance. " That does not mean that they're in network.

So when you call to verify or if you're a patient of ours and you want us to verify the question to ask to where you get the most up-to-date information is I want to make sure that you're in network with my insurance not that they take it because some providers even if they're not in network they're still take it but you're going to be responsible for a lot of money because they're going to get paid at an out of network rate and then they can bill you for whatever's left up to their build amount.

" And we can call. What we'll do is we'll call not only the provider, but we'll also call your insurance company and verify that the provider you're going to is in network.

So, you don't have to worry about doing that. Every insurance also has a Medicare Advantage plan, has a preferred laboratory. A lot of times you can go to both, whether it be Quest or LabCore. There are some smaller labs throughout the United States, but before you go and have your labs drawn, make sure that lab is in network.

Same thing with freestanding imaging centers. You want to make sure because if not, either they're going to deny your claim or there's a chance you could be build for a higher amount because they're out of network. It's always good to verify with your insurance.

Again, it is something we can help you out with. Our advocates are here to answer your questions, to help facilitate these things. I hope you guys have a great day.

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How advocates check in-network providers

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