Once you’ve enrolled in the right Medicare coverage for your needs, you’re all set to use your coverage. Unfortunately, due to the complexities of the healthcare system, you may experience some roadblocks when getting care or accessing certain benefits.
Sometimes it’s something simple, like figuring out how and where to use your OTC benefit. Other times, it’s something more complex, like understanding how to navigate a prior authorization denial or a billing error. The good news is that Chapter is here with you every step of the way.
Chapter’s Medicare Advocates help you push through any challenges that may come up when you go to use your Medicare benefits.
They help with things like:
Answering questions you have about your coverage
Optimize prescription drug costs
Setting up accounts on Medicare.gov and any insurance company portals
Finding and setting up appointments with in-network doctors
Appealing prior authorization denials
Handling incorrect billing and claims issues to ensure you aren’t overpaying
The IRMAA appeal process
They’re armed with insider knowledge that helps them guide you through the healthcare system. That knowledge, paired with their persistence and genuine care for Chapter members, helps them resolve even the toughest cases—all to ensure you get the care promised to you by your plan.
We’re often asked to share concrete examples of how our Advocate team can help. We’re excited to share a handful of our most impactful stories.
Critical cancer care: Out of network, not out of reach
Whether it takes one phone call or 30, Chapter Advocates will do what it takes to make sure you have access to the care you deserve.
When a Chapter member of over two years learned his lymphoma had returned, his oncologist referred him to a leading cancer center for state-of-the-art care. There was just one problem: it was out of network with his Medicare Advantage HMO plan.
Our Member Advocate team got to work. Over the course of a month, Chapter Member Advocate, Colleen, made many phone calls, filed appeals, and submitted network inadequacy requests on his behalf. Her persistence paid off: he was approved for a clinical trial at the cancer center—and at no cost to him.
Colleen also learned he needed an expensive therapy that was excluded from his trial. She went right back to work. She found a hospital in his plan's network that offered the therapy and helped him receive his care there.
Today, he's receiving both treatments without having to worry about spending hundreds of thousands of dollars. Most importantly, he's getting the care he needs, with a team of Chapter Advocates in his corner every step of the way.
Rehab recovery: Room to heal, relief from the bill
Unfortunately, health plans don’t always automatically cover everything they should, and formatting or clerical errors can cause difficult-to-resolve issues. When there’s a denial or billing error, Chapter Advocates are behind you to set things right.
A Chapter member called our Advocate team because she and her husband had submitted a $20,000 bill for his inpatient rehab stay, and they hadn't been reimbursed for months. Her husband had specifically chosen a Medicare Advantage PPO for the freedom to see out-of-network providers. When they called the plan, they learned the claim had been denied without notice.
Chapter Member Advocate, Marsh, found the reason for the denial: the plan wouldn't accept the format of the hospital's super bill. She reformatted over 200 line items to meet the plan's requirements and called the carrier directly to request special handling.
After 45 days of steady follow-up, our member received notice that the plan paid, but only half of what his out-of-network benefits allowed. Within a day, Marsh was on the phone with the claims department and discovered the denials had been coded incorrectly. She filed an escalated appeal, along with a grievance for improper handling.
In the end, he got his full reimbursement, exactly as his plan should have paid it. Most importantly, they could focus on his recovery while Chapter’s Advocates handled the logistics.
Crisis to calm: You’re never on your own
Sometimes it only takes our Advocates one call and a few hours to solve a member’s issue—but what can be simple for us can save a member thousands of dollars and hours of frustration.
A Chapter member living with chronic conditions was unsure how to handle the refill of two specialty medications he couldn't go without, but the cost was more than $45,000 a month. A family member who had managed his health insurance for years had recently passed away. On top of grieving someone he loved, he was also left to navigate his Medicare on his own. He didn't know which prescription drug plan he had, and he didn’t have any information on the pharmacy that was dispensing his prescriptions.
Chapter Advocate, Ray, stepped in right away. In just a few hours, he tracked down the member's plan, found his member ID, located his doctors and specialty pharmacy, and got both medications reordered. Once he secured the member’s refill, he went a step further, creating a contact guide for future prescriptions. He was equipped with all of the information he needed: plan, pharmacy, and doctors—so he'd never be left scrambling again.
What started as a crisis ended with a sense of calm.
We’re here for you
Chapter Advocates are here to make sure your Medicare coverage is working for you. Once you’ve enrolled in a plan through Chapter, you get complimentary Medicare advocacy—forever. Your Chapter Advocates are trained to navigate the ins and outs of Medicare coverage, so you don’t have to.
If you’re not sure whether or not we can help, give us a call anyways. We probably can.
Give us a call at (866) 652-2427
