Fibromyalgia & Chronic Pain LIFE Summer 2013, Issue 9 - Page 30

Navigating Insurance become familiar with your name and health condition. If a claim is rejected in the future, you have someone to call at your insurance company who is familiar with you and your illness. Hopefully, the representative will be able to help you successfully navigate the claim/appeals process. son with chronic pain actually finds a successful treatment plan that an insurance company would deny their medical claims. However, obstacles can loom ahead of chronic pain patients if their health insurance does not cover some or all of their treatment. The following issues are particularly difficult with no easy answers: • Insurance may only cover parts of the entire treatment plan. Most of the time a successful chronic pain treatment plan is a multi-modal approach. Insurance may pay for medications but not the physical therapy treatments. Or four physical therapy sessions might be covered, but not seven. • Insurance sometimes forces people into a medication step-therapy program before paying for the prescribed drug. Patients may have to try three or four medications before being allowed to use FDA approved pain drugs such Lyrica or Cymbalta. This process can linger on for four or five months, and in many instances patients have already tried the medications they are being forced to use with unsuccessful results. What strategies might work to overcome insurance barriers? • Know your plan and ask questions about what pain medications and treatments are covered. Discover whether a referral from your family doctor or pre-authorization for pain treatment is required. Learn how much your co-payments are and if they are different for specialist care as opposed to your family physician’s treatment plans. • Do not make assumptions about whether paperwork has or has not been done by anyone involved in your care. Always check to make certain that doctors, hospitals, specialists and therapists involved in your pain treatment plan are covered by your insurance. Confirm that claims have been filed with your insurance company and take responsibility for ensuring paperwork THE PATIENT ADVOCATE ADVANTAGE Often when a person is in pain and doesn’t feel well, it can be confusing and difficult to focus on information shared at doctor’s appointments or remembering treatment regimens. This is when a patient advocate can be beneficial. There are different types of health advocates. • Sometimes health insurance companies have advocates available who are part of their clients’ plans. It may be your responsibility to review the policy for this information or call your “friendly” representative and ask if your insurance carrier offers patient advocate help. If such a service exists you may be able to request that the advocate accompany you to doctor’s appointments to help record treatment options and to ask questions. Having an advocate inside the insurance company can be a vital asset, especially if there is a discrepancy on a claim. • Another type of advocate can be a family member or close friend. This person should be committed to accompanying you to doctor’s appointments, taking notes and recording answers to your questions. When you have problems recalling details of the appointment, such as instructions about which medication you should take at different times of day or what the side effects might be, you will have your advocate to remind you and help answer your questions. This second set of eyes and ears can be essential to your health care and valuable in helping to decipher your insurance claims and doctor bills. It seems incomprehensible that once a per30  Fibromyalgia & Chronic Pain big Question: Will Insurance Cover Your Pain Treatment? Life Summer 2013