Recently, I was forced to change health insurance companies. For the new year, my former insurance company was dropping all individuals in my area because they canceled their contracts with five of the major local healthcare institutions. If I opted to remain covered by them, I would have had to switch to an HMO-type option and see doctors not in my hospital network. To me, this was unacceptable.
I went on the Affordable Care Act Exchange and found an insurance company that offered me a PPO and included all of my physicians within their network. I picked my deductible, filled out the paperwork, paid for my first month and was told I was good-to-go. The process was easy, or so it seemed.
About half-way through January I received a letter notifying me that my new insurance company no longer had a contract with the hospital system for which my neurologist works. They explained that I would have to find a new doctor to treat my multiple sclerosis. There was no mention of the option to pay out-of-pocket and remain with my current doctor of 10 years. This last-minute switch was upsetting, to say the least.
Three days after the above mentioned letter came; I received another letter, this time stating that the insurance company did not feel my condition indicated the need for such an expensive medication and that other less expensive options were available and I needed to switch to one of them. My Tecfidera was no longer covered. My entire body began to shake and my eyes teared up. This medication without insurance costs $72,000 per year. What do you mean I no longer need it and it’s no longer covered? Who are they to dictate my care? Isn’t that my doctor’s job?
Sadly I became so irate my body started to shut down. I could feel my hands and feet tingling and buzzing while my face, tongue and mouth became numb. The ringing in my ears grew so loud I could barely hear. And, I was shaking uncontrollably. At first, I recognized that I needed to reign in my stress and calm down or I really was going to become quite sick. Secondly, I thought, what do I need to do to rectify this situation? My calls to the insurance company went unanswered by anything more than a recording.
I reached out to my neurologist and after leaving two voice messages and one email, someone called me back (yes, persistence pays off). They remained unalarmed and explained that they would do their best to rectify this matter. After 10 days of talking to several people at my insurance company, the doctor’s nurse was able to get my medication approved for one year. Phew, what a relief! Although we’ll have to jump through the same hoops next year if a better insurance alternative doesn’t become available.
If you are experiencing the same red-tape runaround I did with my insurance company, call for reinforcements. Your doctor’s office and the drug company want you to stay well and on your medication. They will do whatever it takes to help you navigate your way through the insurance nightmare. Although I did not have to resort to contacting the pharmaceutical company for Tecfidera (Biogen), they did inform me that if I had any trouble getting my medication, they would bridge me a month or two of medication until I was able to get coverage.
Bottom line: If you have trouble with your health insurance coverage, stay calm and reach out for help. Your team wants you well and will help you as best they can to achieve that. Do not be complacent or get angry as nothing will come of that. Instead, try to be proactive, calm and polite. Remember, the people with whom you speak are only employees, not the decision-makers.
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Barbara inspires hope through mindful health and a meaningful life. By combining healthy living, spirituality, and neuroscience principles, she helps people understand how to be proactive in their health care versus reactionary in their sick care so they can feel great in their body and in their life. Her greatest wish is to never hear a person say, “I should be taking better care of myself.” To learn more and receive her FREE guide, visit Appelbaum Wellness.