Dealing with the healthcare industry can frustrate the most knowledgeable patients as well as the providers and professionals who work within it. Complex organizations trying to accommodate equally complex personal situations can lead to an agonizing balancing act between a patient’s needs, a doctor’s directions, a healthcare system’s policies and procedures, and an insurance company’s rules, requirements, and responsibilities.
And the unfortunate truth of the matter is that a large portion of those frustrations land squarely on the shoulders of patients themselves.
Coordinating your healthcare isn’t always going to be easy, but there are some tangible things you can do that will hopefully lessen the burden and ease some common sticking points. Below we’ve collected some key actions any patient can take to help find their way through the system. And it should be noted that while this advice comes from a U.S. perspective, many of the suggestions below will be relevant for our international readers, as well.
Understand Your Insurance Plan: Become an expert on your own insurance plan, and if possible, identify someone who can help you. If your insurance comes from your employer, there may be a colleague or insurance agency representative who can help answer questions or walk you through anything you don’t understand. And your insurance company itself is there to help, too. Of course customer service can be one of the most frustrating things to deal with, but ultimately that might be the best place for answering many questions, voicing concerns, and hopefully getting any problems resolved.
Get Help at Your Doctor’s Office: Most medical offices have staff that specialize in insurance-related issues and can assist you in navigating insurance’s complexities. Seek out the person or people on your doctor’s team who can help, and make sure they know you. If you hit a roadblock with an insurance company, an advocate inside your neurologist’s or PCP’s office may be able to step in and assist you when needed.
Even More Records: Documenting discussions with insurance companies is something that’s often overlooked, but can be incredibly important. You’ll rarely be dealing with the same person from one interaction to the next, so it’s vital that you know who you spoke to, when you spoke to them, and what you talked about. Keep a running account of issues that have been discussed, and any resolutions or conclusions that have been reached. And whenever possible, get it in writing. Ask for documentation and keep it on file when you get it.
Clarify Preauthorization Requirements: Make sure both you and your medical team are aware of your insurance company’s preauthorization requirements for any procedures your doctors want to perform. A mix-up in preauthorization can interrupt your care if a provider isn’t able to perform it, or even worse, leave you on the hook for the cost of an expensive procedure your insurance company didn’t approve.
Get Help When You Need It: Consider enlisting the help of a patient advocate, social worker, or healthcare provider familiar with navigating insurance issues, especially if you’re facing complex or challenging situations. And as mentioned above, reach out to your doctor’s office to see if their staff can assist you. You can also get help from family or friends, who may be willing to assist in dealing with insurance with you.
Utilize Patient Resources and Assistance Programs: Take advantage of patient resources provided by advocacy organizations, support groups, and healthcare providers specializing in MS. These resources can offer valuable information, guidance, and support in navigating insurance-related issues. In the MS world, many drug manufacturers have established Patient Assistance programs that can help you navigate getting and staying on the medication your neurologist has prescribed. These programs can assist you in working with your insurance company, and if that fails, they may also have financial assistance available so you can remain on a medication that your insurance company doesn’t cover.
Be Persistent and Patient: Dealing with insurance issues is often a frustrating ordeal, making both persistence and patience necessary. If you encounter obstacles or denials, don’t be afraid to follow up with your insurance company multiple times to advocate for coverage of the treatments or services your medical team has prescribed. Above all else, take care of yourself, and if you need to take a break, do so.
