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Blog: Living Mighty Well

What to Do When Your Insurance Doesn't Cover Your Treatments

Have you recently discovered that you have a chronic illness, or know someone who has? Despite all the changes and challenges you’re going through, you’re comforted - even for just a little bit - with the fact that you have health insurance. Only to find out later, that your insurance won’t cover some of your medicine or supplies, like long-term PICC line use.

insurance coverage not approved

 

At Mighty Well, we heard about people who have experienced the same challenges with their insurance. So, we asked our community to share  the steps that they took to confront this situation. 

 

Find someone that can help you.

Before doing anything else, make sure to equip yourself with all the information about your insurance. Insurance policies are often confusing, convoluted, and overwhelming.

You can ask a friend or family member who has had a similar experience to help you better understand health insurance policies.

If you’re not comfortable discussing your insurance policy with friends or you don’t have a family member that can help you, you can ask help from social workers or health advocates. You can ask your HMO, hospital, or clinic if they have someone that can help you negotiate with your insurance company. Plus, they can help provide additional financial resources that you might qualify for.

If there is no social worker or health advocate in your clinic or hospital, you can reach out to Patient Advocate Foundation. They can help negotiate with your insurance.

If you ask the right questions and talk to the right people, you can get more information and find ways to get your claims approved.

More importantly, you’ll most likely feel weak from treatments and you won’t have the energy to argue with your insurance company. Having an advocate is always a huge help!

Here are some tips from our Friends in the Fight: 

 

Call your insurance:

Find out what’s going on and find ways to get your claims approved.

If that doesn’t work, request a letter of medical necessity from the ordering physicians. If it’s a physical therapy, you can ask the physical therapist.

Some physicians will actually call the insurance, so you can ask them to record the requested service and resubmit it.

-Darcy P.

Check state laws:

In some states, such as Rhode Island, coverage for long-term antibiotics is mandated for Lyme Disease. However, be warned. A self-funded insurance policy is not regulated by state laws, but are governed by federal laws.

If all else fails, find ways to get your medication and supplies cheaper.

The website GoodRx.com is my go to place when a medication is not covered by my insurance company. The cash price without insurance is cheaper in some cases.

-Michael T.


Work with whatever resources you can afford or find:

I strongly encourage all forms of naturopathic treatment. Naturopathic treatments bring positive results based on my experience.

-Katie L.

Naturopathic treatments might not work for everyone, but learning more about it could be helpful.

Have you experienced something similar with your insurance company? How did you handle the claim?

 

Share your experience below or connect with our community on Friends in the Fight   to join the conversation. 

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