It’s 3 a.m. and you wake up with a hard pain on the right side of your abdomen. Could it be appendicitis? Do you need to get to the ER? Or might it be gas? What to do?
Many people in such a circumstance consider turning to toll-free 24/7 help lines provided by their insurance plans. Staffed by registered nurses, most are designed to offer free advice on everything from troubling symptoms to minor illnesses, injuries, chronic conditions, fitness, nutrition and other health-related topics. Insurance companies often have “specialty” lines geared to particular problems, such as diabetes, pregnancy, or other common conditions.
Some advice lines, particularly those associated with a health maintenance organization or HMO, will even help set up an appointment at their urgent care clinic or with your regular physician, potentially bypassing a virtual waiting list and getting you seen more quickly.
But some people resist the urge to call because they wonder just how confidential their conversation with an advice nurse would be. Could something you say be linked to your insurance account and used as evidence of a chronic or pre-existing condition? Is it possible that your conversation could end up raising your premium?
Susan Pisano, spokesperson for AHIP, a national trade association representing the health insurance industry, in Washington D.C, says yes, it could.
“It’s different from calling an anonymous help line,” said Pisano. The advice nurse will ask for your insurance membership number right from the start of the conversation.
Pisano said that while the situation may vary between particular insurance companies, in many instances “records to the call line may be placed in a member’s file and sent to their health provider.” The advice line staff may also follow-up on your call, either to check on your situation or to provide additional information or guidance. “Someone should assume that’s the case,” she said.
In most instances, Pisano said, you’ll end up having to seek direct medical care and your situation will end up part of your physician’s medical record anyway.
She says that if you should end up shopping for health insurance on your own – outside of an employers’ coverage plan – you would be legally obligated to tell the prospective insurer about any health event or condition, however it was determined.
But she also emphasized that nurse lines have been established for the benefits of members and are not designed to deny coverage.
Using a nurse advice line may help you avoid a time-consuming and potentially expensive trip to the emergency department. People often can’t figure out whether they need to be seen immediately. Talking to an advice nurse may help you feel better about waiting to see your physician, or could convince you that the emergency department is what you need now.
If you call a nurse advice line, there are a few things you can do to make the call go more smoothly and productively:
· Have your health insurance membership card ready
· Have a list of your current medications
· Be ready to tell the nurse about your health issues and any chronic diseases or conditions
· If you’re calling with a health problem, make a list of symptoms, how long you’ve had them, and any other details that may be helpful.
· Have a pencil and paper handy so you can take notes. It’s easy to forget what you hear, especially when you’re worried or concerned.
· Be sure to monitor your condition, or go to your doctor if that’s necessary, so you won’t need additional follow-up calls over time.
Barbara Bronson Gray, RN, MN, is the founder of the blog www.bodboss.com, which is “dedicated to helping people learn to be the CEO of their own body and better guide their own health care.” Besides her hands-on work as both a nurse and supervisor in hospitals, Barbara has written articles that have been published in a number of national magazines and newspapers. Follow her on Twitter: @bbgrayrn.
