What Can I Do If My Insurance Won’t Cover My Psoriasis Medication? A Q&A with Dr. Truong
This article is part of a Q&A series in which a healthcare professional in our community answers your frequently asked questions.
We asked: “My health insurance won’t cover my psoriasis treatment. What can I do?”
Allison Truong, M.D.: Managing a chronic condition like psoriasis and navigating your health insurance can be challenging at times. One thing that I have found very helpful: Being your own advocate helps. That means you should:
- Do your research and educate yourself about psoriasis.
- Know what treatments are available to you (which often depends on psoriasis severity).
- Understand what your insurance company will and won’t pay for.
- Come to each doctor’s visit prepared with a brief list of questions to ask.
You and your doctor should share in making decisions about how to best treat your psoriasis. If you have concerns about what the provider suggests, don’t hesitate to speak up. It’s perfectly okay to ask questions and say what you’re thinking.
When you collaborate with your provider, you’re more likely to get what you both want. For example, if you’re afraid of needles, you may decide to start with an oral medication. But if you’re afraid of needles but still want to try a biologic medication, then you might ask your doctor to allow you to come into the office so you have support for each injection.
You can ask your doctor to advocate to the insurance company for you. In my experience, when staff go to bat for their patients, we can often get them what they need. Don’t take the first no for the final answer. Sometimes, it takes more than one try to get the insurance company to approve what you and your provider have decided is the best course of treatment for you.
According to HealthCare.gov, you may be able to file an appeal with your insurance company if you’re turned down for coverage of a medication you need. According to law, your insurance company must tell you why it has denied your claim and how you can file an appeal.
You can file an internal appeal, which means asking your insurance company to conduct a full and fair review. To file an internal appeal, you can use forms that your insurance company must provide, or write a letter that includes the required information and submit it to your insurance company.
If you still have no luck getting your insurance company to approve coverage for your desired psoriasis treatment, you can take your appeal to an independent third party for review. This is what’s known as an external review. In an external review, the insurance company doesn’t have the final say whether or not to pay a claim—the third party does.
While working on an appeal, keep copies of all your bills and responses from your insurance company and any notes you have from visits or phone conversations with your insurance company and provider related to your appeal.
Also, do ask your doctor for something to hold you over while you wait. Sometimes, doctors have samples of the medication that they can provide for their patients in the meantime. The process may take some time, and it doesn’t hurt to get started. The most important thing to remember is to be patient and persistent.
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