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Dr. Bill's Commentaries

Another Titanic problem: getting a new medication paid by your health insurance   (July 23, 2007)

I recently read a comment from a patient who was having problems with an insurance company:

"I called this number and another one and both told me that there is nothing that they can do to influence the insurance company to cover the medication. The only thing that they can do is send my doctor a letter that they can forward to the insurance company. It does not guarantee that they will cover the medication after all this.

"I am working with my insurance company right now and will see what happens by the afternoon what steps I will need to take next."

What steps next? My answer is simple:

  1. Definitely, your next step is to request that your physician write a letter (on his/her letterhead!), send it to your insurance company, and send you a copy, which spells out that the use of the medication is "medically necessary."
  2. Then plan on contacting your insurance company -- repeatedly. I once jokingly said that the insurance company throws away your letter the first two times, reads the third then throws it away, then finally on the fourth or fifth time, responds to the request.
  3. Also, if your insurance is funded by your employer, point out to the folks at your company (or your union) that you're having trouble arranging coverage. Sometimes, you might get a response that is helpful in pushing the icebergs aside without sinking.
  4. If you're in a financial crunch, there are programs that will assist in paying for medications: besides those run by the government for indigent folks, many pharmaceutical companies have programs - be sure to contact the manufacturer of your medication.
  5. But if you truly need the drug, and don't get satisfaction soon, start the medication, and keep your receipts on the hope that someday you might get reimbursed.
  6. If nothing else works, then plan on contacting your legislators and let them know, step-by-step, what you've tried. And let them know what you think!
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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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