How to Organize Medical Paperwork

Tons and tons of paper work is an inevitable by-product of the appointments, therapies, and interventions your child’s complex care requires.  There is just no way to avoid it. It can feel overwhelming as the bills and insurance EOB’s (explanation of benefits), IEP’s and evaluations, etc. all come pouring in.  What to do with it all?

All of these papers tend to pile up, which leads to mental disorganization and chaos.  I can’t tell you how many times I have experienced a terrible moment of panic when I needed to find an important paper I hoped was lost in a pile somewhere.  Eventually, I learned a better way.

Below, is my time tested system for how to organize medical paperwork and eliminate the mental stress record keeping often brings.

The key to any good file system is not to let papers pile up and to deal with them as soon as they come into your home.  Just taking a few minutes, every day, to sort and file your mail will make a big difference.  Doing so, means that you won’t have piles of papers to work through, in a panic, when you need to find a critical item. You will have the reassurance of knowing that you can easily find and reference important papers whenever you need them.

You will want to have a file system that is in view and easily accessible. I like to keep mine right on my kitchen counter so that I am more likely to file my paperwork on a daily basis, as soon as it comes in the house. I know that if my file system is kept out of sight, it will also be kept out of mind. It needs to be as convenient as possible or I will be tempted to let papers pile up until I am forced to deal with them later. By then, they are much harder to organize.

You will want to invest in a sturdy file box and heavy-duty file folders capable of holding large amounts of paper. Ideally, you will re-use this system year after year and, for this reason, you want the products you choose to be durable enough to last.

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The products I use for my file system:

I purchased this wooden file box at Target – It is durable and I like that it coordinates with the style of my home since I keep it in a very visible spot.  It is what I would call a half-file box. This is generally big enough to fit all of my family’s medical and household files for the year. However, depending on your circumstances, and the amount of files you have comin in, you may want to create separate file boxes for your household and your medical paper work or consider a larger size.  Evaluate your current needs, as well as potential growth, before making your purchase.

My file folders were purchased through Amazon. They come in a large pack of 25, at a very affordable price, compared to what I have seen at office supply stores and big box stores.  I like the jewel tones but they have several other colors and styles to choose from. Have fun with it!  Remember that whatever file folders you buy, you want them to be heavy duty and to have the metal hangers that slide nicely in your file box.

 Now that you have your supplies, it is time to personalize your own file system. Let's talk about the categories of medical paperwork you might want to include in your system.

Insurance Explanation of Benefits (EOB’s):

You will need the following file folders: 

• EOB – (family member’s name)– Have one separate folder for each family member in which to file insurance EOB’s for that person’s medical care. If you use more than one insurance provider, make separate files in the same way, for each provider.
• Appeals– Have one folder for each insurance provider with whom you file an appeal. *Optional

Keep a separate insurance, file folder for each member of the family.  It is so much easier to find the EOB you need when you know which family member received the service being billed. This is where you will look anytime you need to reference documentation of your benefits, for a particular person or service, or need to verify the accuracy of the amount you are being charged.

*Note: This is also where I keep documentation of any insurance appeals that I have pending. This includes notes from phone conversations and copies of any correspondence and paperwork related to the appeal.  In my experience, appeals have been a rare occurrence, so I do not feel that I need a mandatory file for this category, creating them only as needed. However, if you find that you make several appeals a year, you may want to create a separate “Appeals” file for each insurance provider.

Paid Medical Bills:

You will need the following files:

• Paid Medical Bills– Have one file to store all paid medical bills.
• Payment Plan (Care Provider)– Have one file folder per care provider with whom you have a payment plan. *If Applicable

When you receive a medical bill, find the corresponding EOB from your insurance company and compare the amount you are being charged by your care provider and the amount your insurance company says you are responsible for are the same. Mistakes do happen and time frames for processing claims can mismatch so it is worth verifying this information before you pay your provider.  If they match, pay the bill. Keep a copy of the paid bill and mark it with the form of payment (check, HSA, credit card, etc.) you used and the date it was paid.  Attach the corresponding EOB to the copy of the paid bill. Keep the attached papers in the file folder labeled “Paid Medical Bills”. This is where you will look if there is ever a question of whether a bill was paid.

*Note: Generally, all paid medical bills can be filed together.  However, if you are on a payment plan, I recommend creating a separate file for that service provider. This will keep the records of payments made to that provider separate and easy to reference should any changes need to be made to your payment plan along the way.  In this circumstance, create a separate file labeled for each service provider with whom you have a payment plan.

Health Savings Account (HSA):

You will need the following files:

• Health Savings Account (HSA)– Have one file for each HSA, flex spending, etc. account(s) you have (hereafter grouped together and referred to as HSA for simplicity), as applicable.

Keep copies of all of the bills  that you have paid for with your health savings account in this file. Make note on the copy of your bill that they were paid with your HSA and on which date they were paid.  If you got a receipt from your provider, which I suggest you make sure to request at the time of payment whether paying in person or over the phone, attach it to this copy of the bill.

Also, keep all receipts for prescriptions, medical supplies etc. that you purchased with your HSA account in this file.

This is where you will also keep bank deposit stubs for any deposits made into your HSA account.  It is important to keep record of your deposits for two reasons:

First, money can be deposited into your HSA account pre-tax.  This is most easily done through your employer but you can also make personal donations as well, up to a certain cumulative annual amount. If you make deposits into your HSA account it is important to have documentation to give to your tax professional, so that you are not taxed on that amount when you file your income taxes.

Second, be particularly careful to redeposit any money you receive as a reimbursement, from your insurance company or care provider, for any bill you have paid with your HSA account. Because that money was originally deposited into your account pre-tax, you cannot simply do "whatever you want" with it. It must go back into the HSA account or you can be penalized. After you deposit the reimbursed amount back into your account, attach the bank deposit stub, along with proof of the reimbursement (check stub or copy of the reimbursement check, for example), to the original bill and proof of your payment/receipt. Since you originally paid the bill with your HSA, a record of that bill and it's receipt will already be conveniently filed in your HSA folder. 

For example, our dentist requires that we pay our bill on the day of service, even though our insurance will eventually cover the amount. So, I pay the bill with my HSA card on the day of service.  Once the claim is processed, our insurance company will send me a check to refund the amount that they cover.  Then, I make sure to take that reimbursement check and re-deposit the full amount back into our HSA account.  Once that is done, I attach the bank deposit stub to a copy of the reimbursement check(s) I received from the insurance company. Finally, I attach both of these to the original receipt I received from my dentist when I payed my bill, which is already filed in my HSA folder. Easy!

NOTE: Whenever you re-deposit a refund for a payment you previously made using your HSA account, make sure that your HSA bank/provider is aware of this. They must mark this deposit as such so that it is clearly documented that you are returning funds that were once in your account. If they do not, this deposit will be counted as a contribution toward the annual limit of pre-tax dollars you are allowed to deposit into your account each year. You do not want this deposit to "count against you", reducing the amount of "new" dollars you can contribute into your fund. For more specific information contact your HSA bank/provider to make sure you are following proper procedure.

An HSA account can be a very helpful tool in creating a financial safety net for medical expenses. Because you can deposit pre-tax money, your savings can grow much faster.  However, with that privilege comes accountability. It is important to have documentation filed and on hand should any question arise as to how you are using your HSA account.

Financial Assistance:

You will need the following files:

• Organization or Financial Resource Name– Create a separate file for each organization/resource for financial assistance to which you apply.

When I apply for financial assistance, I keep a thorough record of every application I send for a couple of reasons:

First, if you are applying to have a bill paid, you want to make sure that you stay on top of that application so as not to risk delinquent payments on your account. Having good records keeps these pending bills from falling through the cracks.

Second, some financial assistance programs have a limit on how much assistance they will give to an individual recipient in a calendar year.  Thorough records help you to keep track of how much you have received and how much may still be available to apply for.  This way, you don’t waste time applying for maxed out resources and you don’t miss out on needed funds because you didn’t realize they were still available.

In my records, I file a copy of the application, as well as, a copy of every piece of documentation that is required for the application. This may include a copy of the EOB, copy of the insurance card, a refusal letter from the insurance company or documentation of an appeal, etc. I will also keep a copy of the bill or documentation of the expense that I am seeking assistance for. When the application is processed, I will add either documentation that assistance has been approved and received, or documentation that the application was denied. 

Various financial assistance programs are going to have different requirements. For this reason, it is important to take the time to thoroughly document your application so that you can easily reference it later. To make this as convenient as possible, keep your application copies filed in the appropriate folder for the organization/resource you applied to. 

School IEP: (Individual Education Plan or 504, etc.)

You will need the following files:

• IEP/School– Create one file for each child who has an IEP, 504, etc.

In this file, I keep documentation of all communications I have with my child’s school related to her care and education, such as the following:

• Notes I took during the IEP Meeting, including progress reports shared by her team and/or goals set in partnership with the team, as I understand them.
• A copy of the most recent IEP, once finalized.
• Documentation of any updates or amendments made to the IEP, throughout the time that passes between official IEP meetings.
• Copies of letters and e-mails I have written to the school district to exempt my child for testing or certain activities, for example. I print and keep them on hand in this file.
• Copies of important e-mails or communications I have received from the school regarding my child’s care or education. I print and keep them on hand in this file.
• I also keep any evaluations related to school in this file. Whether it is academic report cards or evaluations for how she is progressing in school provided therapy, etc.

An IEP is an agreement that you have with your child’s school as to how they will support your child in their education and in navigating the school environment.  The school is legally required to follow through on the guidelines outlined in the IEP, but sometimes parents find that they fall through the cracks or are blatantly ignored. Even if you have a stellar IEP team, it is important that you have documentation on hand, should you ever need to advocate for your child to receive the services they need and deserve. You can never have too much documentation!

Therapy Providers:

You will need the following files:

• Name of Therapy Provider: Create a separate file for each therapy provider. If you have more than one child being served by a provider create a separate file for each child.

In this file, I keep documentation of therapy plans that we have prepared in partnership with our therapy provider(s).  It is also great to keep evaluations and progress reports in this file, so that you can see your child’s progress throughout the year, evaluate what is working, and determine which areas may need more attention in the future.

Similarly to the School/IEP file, it is important to keep these records on hand so that you can easily refer to them should you need to further advocate for your child’s care.

Test Results and Reports:

You will need the following files:

• Name of Care Provider: Create a separate file for each specialist/provider with whom you have important tests/scans/evaluations etc. If you have multiple family members served by a provider make a separate file for each person.

You have a right to access all of the test results, reports, scans, etc. for your family. It is up to you to decide which of these you feel are important enough to keep in your personal file. Depending on your situation it may be beneficial to request copies of these results to send for second opinions, etc. Your care provider will help to facilitate sending records to other providers should you request a second opinion or need to transfer care.  However, depending on your circumstances and how frequently and quickly you need that to happen, it can sometimes be more efficient to have those records on hand to send yourself.

In some cases, annual or quarterly testing for example, one file may be adequate. However, if your child is in active treatment and you are compiling a lot of information on a consistent basis, you may want to consider another organizational system for medical reports. In this circumstance a medical binder works well.

The Parachute Project™ Caregiver Planner has all the planning and record keeping resources you need to take control of your caregiving role and eliminate the mental chaos that comes with trying to manage it all.

Second Opinions:

You will need the following files:

• Second Opinions– Create just one file folder to hold records of all second opinions you request.

Second opinions are an important tool in managing your child’s complex care needs. Seeking a second , or third, opinion is always a good idea, not just for your child's well-being but for your as well. In my family, we gather second opinions anytime something changes with Our Girl’s condition so that we know we have all the information we need to make decisions going forward.

Different specialists and providers are going to require different sources of information in order to evaluate your child's case and offer their opinion. You want to make sure that you are efficient in providing this information necessary to facilitate the process and they will be providing valuable, quality information to you in return.

For this reason, it is important to keep thorough records of the second opinions you request in order to reference past advice, and to facilitate future connections, should your child’s needs change. In this file, I keep records of all second opinions we request, including the following:

• Contact information for the specialist, and most likely their nurse or case manager, so I know how and who best to contact with questions now and in the future.
• Copies or documentation of what records were sent.
• The date on which they were sent out, so that I can follow up and make sure they arrived after an appropriate amount of time. I have had records sent to the wrong person before, so I always follow up.
• Information on how long it will be before I can expect to hear from them. Again, so I can follow up if that time passes, without word.
• A list of my questions and their answers.
• Documentation of their official opinion and recommendations.

Seeking a second opinion can be very intimidating, especially if it is your first time. However, it does not need to be difficult. Your current care team is available help you gather records and send them to any providers you would like to consult with. Do not be afraid to ask!

It is common for parents who are new to caregiving to fear that they will offend their current care professional by suggesting that they want to seek a second opinion. Do not be concerned about this! Any health professional, worth their salt, knows the importance of a second opinion, not just in terms of creating a care plan, but for alleviating your questions and concerns as a parent and caregiver.

READ MORE: 5 Reasons You Need a Second Opinion

How the System Works:

The beginning of a new year is the perfect time to put this organizational system into practice.  You can choose to keep it as a dedicated medical file system or easily add to it to create a general organizational system for all household paperwork.

Throughout the year, you will consistently organize all of your mail and other sources of incoming paperwork into their appropriate files as they come in. No procrastinating! No piles! 

At the end of the year, I take all of the papers in my file system that need keeping and move them into a “long-term” file cabinet. They are no longer in plain sight or easily accessible but I know where they are and I still have them “on hand” in case I would ever need to reference them later. Anything, that doesn't need to be kept is burned or shredded.

The IEP file is the only one that is not dependent on a January start to a new year. It remains in the file system until the next scheduled IEP meeting when the files are updated.

When moving the papers to the long-term file cabinet, I make it a point to maintain a separate file for my HSA account documents.  However, the rest of the files can be consolidated a bit. I create just one file to hold all of my family members insurance EOB’s and paid medical bills. I also have just one file for all financial assistance applications made that year, regardless of the source. I also create just one file for all therapy providers/medical reports for the year.  These files, along with the HSA file, are stored together and labeled by the year.

The caveat to this end of year “clean out” is if I have any outstanding bills or financial aid applications, etc. still unresolved at the end of the year.  However, this is almost never an issue as deductibles, assistance limits, IEP meetings and therapy evaluations, etc. are almost always met and resolved well before year end.

I have shared with you all of the ways that I have personalized this file system to organize my family's medical/care related paperwork over the years.  While your family/personal needs are going to depend on your specific circumstances, this file system is flexible and customizable. The most important thing is that you adapt this system to work for you. You need to enjoy using your system, and its benefits, so that you will stick with it month after month, year after year. It make take some time and trial and error to work out the details but I encourage you not to give up. This simple file system can help you to finally take control of your paper and enjoy the confidence and peace of mind that comes from knowing your records are organized and accessible.  

Self-Care Action Discussed in This Post:

Create a personalized file system for your family’s medical paper work to eliminate the mental disorganization and stress that comes from not having your important papers organized and accessible.

Related Posts:

• 5 Reasons You Need A Second Opinion
• 5 Quick Tips for Mental Self-Care
• 5 Quick Tips for Financial Self-Care
• 10 Hospital Stay Survival Tips for Caregivers
• Hospital Stay Survival Kit for Caregivers