Insurance coverage is a hot-button topic. One of the biggest issues we at Sunrise Advocacy encounter is getting insurance companies to actually cover medications and treatments prescribed by physicians. Very often, insurance companies want to substitute their judgment for a doctor’s and will only pay for a cheaper medication or treatment first. However, who should really decide which medications and treatments are best for your specific condition? The answer is clear – your doctor and you!
If your insurance company has denied your claim for the medications and treatments that you need, you don’t have to settle! You CAN call the insurance company and negotiate on your behalf!
To help you be better prepared for the conversations you need to have with the insurance company, we provide you the following steps that may push your insurance company to cover previously denied medications and treatments:
Prepare for your conversations.
- Find out what is actually covered by your plan. Just because your request was denied, it does not necessarily mean that your particular medication or treatment is not covered by your insurance.
- Discuss the other treatment options with your doctor. Find out why these other options ARE NOT right for you!
Talk with your insurance company.
- Insist on a conversation with a decision maker.
- If you don’t get satisfaction with the first person you speak to, ask to speak to a supervisor.
Persistence can often get you the medications and treatments that are best for YOU! Just make sure that you set aside the time to have these conversations, with both your doctor and your insurance company. You will be amazed at how a little time and tenacity can work on your behalf!