Most of us have probably had the unfortunate experience of being denied a health insurance claim for treatment or a drug. When it comes to Migraine disease, its treatments are often found to be experimental by insurance companies. There are a few steps we can take to fight for our health care.
Make sure you know your health care policy inside and out. Do you need to have certain procedures pre-approved? We are responsible for collecting all the information before we dispute or appeal our case when coverage has been denied. If you are unclear about your policy, place a call to the human resources department (if your insurance is through your employer) or even the health care's customer relations department. They are there to help you.
This is the time to make a file for all the papers, facts, claim forms, denial letters and all correspondence with the insurance company. You will need this every time you speak with your insurer. After you have your "file" ready, call them and state your case clearly, calmly and concisely. During this call, remember it is vital to write down the name of the person you are speaking with, the date, outline of the conversation and what they said the next step would be.
If your dispute isn't resolved with the first phone call, you have the right to an appeal. This is where it gets interesting. If the insurance company is denying the medication you are taking because it is not FDA approved for Migraine disease, how can they approved the other non-FDA medications you have taken? Gather facts from the internet or public library from medical journals showing the medication or treatment is effective in treating Migraine disease. Show them articles stating Botox is clinically proven to help reduce Migraine pain, if that is what you are appealing. Giving them your records showing all the failed treatments. Of utmost importance is to file your appeal in the specified time your insurer gives you. If you miss your deadline, you are out of luck. Some advocacy groups, such as the American Diabetes Association, may help with your appeal. Other groups for people with chronic conditions can be helpful as well.
Forty-three states, including the District of Columbia, have some form of a Patient's Bill of Rights. Most of the time, this law gives patients the right to an independent medical review when your claim has been denied or your insurer won't give you the green light to see out-of-network providers. Here's the thing. Most of us don't use this option. After we receive the denial, we tend to say it's over. Never say never. Go for the review, push the insurer to really look at your case, not give it a standard no.
Andrews, Lori. "Fight for Your Health Care." Parade Magazine, The Buffalo News, Sunday January 20, 2008.
Published On: January 25, 2008