Multiple Sclerosis : Know Your Coverage
- Sunday, August 2, 2009, 9:57
- Multiple Sclerosis
- 260 views
- Add a comment
- Dick:
- Now we’ll turn our attention to Jan Shilling. What are some of the major challenges that MS patients face related to insurance?
- Jan:
- The first thing is just maintaining insurance. I think a lot of insurance consumers are daunted by the increasing costs of insurance premiums. The key to being an informed consumer and an advocate for yourself is realizing what those premiums support and don’t support. I always encourage patients, if there is some reason that they’re needing to select insurance or change insurance, to really be informed about what is offered by that particular policy because a policy that may seem less expensive but that has medication benefits – pharmacy benefits – they might want to check because there are some that have caps of $2,000. The cost for treatment for multiple sclerosis is much more than that on an annual basis.
Also in the United States, unfortunately, a lot of insurance is keyed into being employed and maintaining employment, and for a lot of people with MS, that is a key issue. Before you attempt to work with your employer, make sure that you are informed about what would be the most appropriate steps for you. You can do that by consulting with your physician’s office, by trying to work through a vocational counselor, or even consulting with the MS Society so that you’re aware of what might be the best way to work through some of those situations.
There is the other situation of people needing to get insurance once they’ve been diagnosed and then having pre-existing conditions. I’m not familiar with all of the insurance laws in the various states, but a lot of them have an exclusion where you need to wait for a period of time before your insurance will cover a pre-existing condition and if it will even cover it at all.
So, those are all things that people really need to look into and be informed and, if necessary, get assistance from the insurance commissioner or other sources that might be available.
- Dick:
- Are there similar challenges for those whose insurance is provided by Medicare?
- Jan:
- There are, because Medicare does only cover 80 percent of a particular benefit. That leaves a 20 percent that needs to either be covered by what we call a Medigap insurance, which can be purchased by a person or provided by an employer, or they need to pay that out of pocket.
- Dick:
- You mentioned Medigap, and that’s probably one strategy for people whose insurance is provided by Medicare. Would other strategies begin with becoming very familiar with the limits of coverage that your carrier provides?
- Jan:
- I really think so. It’s always frustrating for them, and myself, when we’re trying to work with an insurance company, and the patient or the family isn’t very familiar with what the coverage includes or excludes. Sadly, as health care providers, few of us know what exactly every insurance covers, and so it’s really up to the patient to be really aware and to come in armed with that information, including what may or may not be on the insurance formulary.
- Dick:
- So, part of managing this disease is also managing the information around your insurance coverage, becoming very familiar, and becoming a strong self-advocate.
- Jan:
- You’re exactly right.
About the Author
admin has written 208 stories on this site.
Write a Comment
Gravatars are small images that can show your personality. You can get your gravatar for free today!