RA Tips: Navigating the Health Insurance Maze

285 RATipsBy Seth Ginsberg, Co-Founder, CreakyJoints

Few things are as frustrating as dealing with one’s health insurance company. I know. I’ve been battling arthritis since I was 13. Based on years of personal experience and my work as a patient advocate, here are some tips to help you better navigate the maze:

First, know your plan. Yes, even if reading it makes you feel like your head is going to explode, read it closely, make notes, and highlight where it references tricky issues like  prior authorization requirements (things that require doctor’s approval), exclusions (what isn’t covered), out-of-network restrictions (where you can and cannot go for treatment), and referrals to specialists.

Stay organized and keep detailed paperwork. Even if everything inside you screams at keeping records, you need to play the same game as the insurance company. Keep notes of symptoms, doctor visits, records of your calls to the insurance company (and what was said). Don’t leave anything to memory.  And, keep a folder with a handy list of reference names and phone numbers, along with receipts and their corresponding EOBs (Explanation of Benefits). If you can keep these many pieces organized, everything will be ready if you decide to appeal a denied claim. This will cut down on major stress during an already stressful time.

Try and be polite to the insurance company representative even if it’s tearing you up inside. That’s right—instead of yelling or getting in a huff, act rationally and politely find out why your claim was denied. You can then use this information to correct the error, or further your appeal. To show you’re serious, ask (politely) for the denial in writing, and ask (persistently) for your records. Always remember, you’ll catch more insurance claims representatives with honey.

Look to create a partnership with the insurance company even if you would never have any of these people to your house. Nobody likes the “us versus them” mentality, so approach your provider in a cordial and friendly way. Remember, people who work for insurance companies are people too. Become partners or allies with your case manager, or the group policy administrator at your office, or the administrators in your doctor’s office. Holiday cookies (they don’t have to know if they are store bought) and thank you cards can make a huge impact and help you advance your cause.

And please, pick your battles. Unfortunately, David did not win every battle against Goliath. Be strategic. Pick the battles you think you can win, and recognize the ones that are longshots. Battle for what is medically necessary instead of wasting energy over billing discrepancies. Doctor’s will go to bat for you if it is regarding the need for a treatment—not so much if it’s a payment issue.

Finally, when it comes to health insurance and anything arthritis related, CreakyJoints can help. Consider signing up for our free newsletter at CreakyJoints.org and get the information you need. Join the conversation with other RA patients with CreakyJoints on Facebook: Facebook.com/CreakyJoints. And, for more on how to share your story, to help prevent others from experiencing what you had to go through, visit FailFirstHurts.org.  _

Seth Ginsberg is the founder of CreakyJoints, an arthritis advocacy organization with over 55,000 registered users online. For more than a decade, CreakyJoints has been helping those of all ages with arthritis better manage their condition through its innovative educational initiatives and vibrant, engaged community.