Insurance coverage concerns and difficulties while seeking care for chronic fibrosing ILD with progressive phenotype.
Insurance coverage concerns and difficulties while seeking care for chronic fibrosing ILD with progressive phenotype.
Transcript:
Dawn Repola: During my journey, a couple of things have happened. One of the reassessments I made had me close my businesses, and because of that I lost access to health insurance. Then I had to go into the marketplace to buy health insurance. I am very appreciative that I live in Colorado, where we have a progressive view about the marketplace.
We have a progressive governor, and we’ve done some things here to help mitigate the cost of that, but buying your own health insurance is quite expensive, and being an individual in the marketplace is an expensive proposition. I was grateful to find a good broker and grateful to live where I do.
I had a terrible experience with coverage for my portable oxygen concentrator. It ended up being a protracted battle with the insurance company for a year.
This was a benefit that I had called about, and they told me it would be 100% covered. I made the purchase. I submitted it for reimbursement, and then they told me they weren’t going to reimburse me for it. I battled with them for a year, and finally I gave up. I even brought in a regulatory agency here and had them try to help me with it. I’m someone who has a background in business and in health care, and I’m pretty high functioning and can have a cogent conversation. But if that can happen to me, it can happen to anybody. I have a really hard time understanding what drives that decision when all the people I talked to at the insurance company told me that this should have been a benefit that was covered 100%.
That was really disappointing. The other thing that happened around coverage was I switched insurers this year—the specialty pharmacy isn’t new to me—and my medications, which are generic, went from being $87 to around $675 a month. I went on GoodRx and looked for a better price and found that. It’s more convenient to get it from my local pharmacy, but that didn’t track for me. That didn’t make sense to me why there was that big of a discrepancy in price.
Increasing Lp(a) Awareness for Better Cardiovascular Health: Dr Mary McGowan
March 24th 2024For Lp(a) Awareness Day, Mary McGowan, MD, FNLA, chief medical officer of the Family Heart Foundation, highlights how most people with elevated Lp(a) are completely unaware that they have this increased risk and calls for increased testing.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Kathy Oubre on Strategies to Mitigate Challenges When Adopting New Payment Models
February 23rd 2024While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.
Read More
Getting to Know Dr Shauna Downs, Public Health Nutritionist
February 23rd 2024Shauna Downs, PhD, MS, is an associate professor in the Department of Health Behavior, Society, and Policy at the Rutgers School of Public Health. A former figure skater, her research now focuses on interventions to promote healthy and sustainable food choices and exploring how our changing climate, food systems, diet, and nutrition are inextricably linked.
Read More