I'm caring for someone else
Healthcare problems are difficult when you are managing them for another person. Get organized, understand the problem and take the right next step.
Start by identifying the problem. Then assess it, decide what needs to happen, take the next step, act and work toward resolution.
One process for every healthcare problem
Work through it step by step instead of trying to solve everything at once.
What problem are you dealing with?
Pick the one that matches the situation. Each leads to a free tool that helps you assess exactly what's happening.
Healthcare bill
A bill looks wrong, unexpected or hard to match to the care that was received.
Assess the bill CARE ACCESSCan't get needed care
A referral, appointment, provider or authorization is stuck or delayed.
Assess care access MEDICATIONCan't get prescribed medication
Price, coverage, prior authorization or a pharmacy issue is blocking a prescription.
Assess medication access INSURANCEInsurance or coverage problem
A claim or service was denied, or coverage doesn't match what you expected.
Assess the denialUnderstand what's happening — no cost
These tools help you assess the situation. They don't resolve it on their own — that's what Premium Resolution below is for.
Healthcare bills
Resolve the problem
Free tools help you understand what is happening. Premium Resolution turns a confirmed problem into a structured case — worked through decision, action, follow-up and resolution.
Care Access Resolution
Turn a confirmed healthcare access problem into a structured resolution case, worked through decision, action, follow-up and resolution.
- Identify the specific access barrier
- Organize the relevant healthcare and coverage information
- Decide the appropriate next action for your situation
- Prepare the information needed for the request
- Track actions, responses and follow-up
- Escalate when the first action does not resolve the issue
A paid resolution service. It does not guarantee an approval, appointment or specific outcome.
Medication Access Resolution
Turn a confirmed medication access problem into a structured resolution case, worked through decision, action, follow-up and resolution.
- Identify the medication access barrier
- Organize prescription, coverage and pharmacy information
- Decide the appropriate request or appeal path
- Prepare the information needed for the request
- Track responses and required follow-up
- Escalate the issue when appropriate
A paid resolution service. It does not guarantee a medication, claim or coverage approval.
Healthcare resources for Canada and the United States
Healthcare rules differ between Canada and the United States, and, where applicable, by province, territory or state.
Canada
Canada's healthcare system operates through provincial and territorial health insurance plans. Drug coverage also varies by program and jurisdiction.
We're building out province- and territory-specific resources over time.
Canada healthcare system Canada.ca Government of Canada: National Pharmacare Canada.ca How to access National Pharmacare Canada.ca Canada Health Infoway: Patients & Caregivers InfowayUnited States
U.S. healthcare access and payment rules can depend on your insurance plan, employer, state and federal program.
We're building out state- and insurance-specific resolution logic into the premium products over time.
CMS: Medical Bill Rights CMS.gov CMS: Insurance Denial Action Plan CMS.gov HealthCare.gov: Internal Appeals HealthCare.gov Medicare: Filing an Appeal Medicare.govCaregiver questions
Common questions when you are managing healthcare for another person.
Can I use The Patient Insider for someone else?
Yes. The caregiver resources help you organize healthcare problems for someone you support. You should have the appropriate permission or authority to access and manage the person's healthcare information.
What should I do when I receive a medical bill?
Start by identifying what the bill charges, compare it with the care received and, where applicable, compare it with the Explanation of Benefits or other coverage information. Then determine whether you need to contact the provider, insurer or another organization.
What if insurance denied something the person needs?
Identify the reason for the denial first. The next action can depend on the insurance plan, the type of service or medication, and the applicable jurisdiction.
What if the person cannot get a prescribed medication?
First identify the barrier. The problem could involve coverage, price, prior authorization, formulary rules, pharmacy access or another issue. Once the barrier is identified, you can choose the appropriate resolution path.
When should I use Care Access Resolution?
Use Care Access Resolution when you have identified a healthcare access problem and need structured, paid help moving from assessment to action and resolution. It does not guarantee an approval, appointment or specific outcome.
When should I use Medication Access Resolution?
Use Medication Access Resolution when a prescribed medication cannot be obtained because of a coverage, affordability, authorization, formulary, pharmacy or related access problem. It does not guarantee that a medication or claim will be approved.