Know Multiple Sclerosis

With job changes come insurance changes as well. It's important to know your rights and the rules of the game. A lapse in insurance can be catastrophic for someone with a disease like multiple sclerosis.

With many treatments costing upwards of $10,000/year, insurance is a must for most of us. The way I understand it, in order to wave the pre-existing condition clause when signing up for new insurance, you must be able to prove that you have had continuous coverage over some period of time. If there is a lapse, then there is a lengthy waiting period before a new carrier has to cover treatment for your condition.

There are all kinds of crazy rules. I actually encourage people to go see "Sicko" by Michael Moore. Yes, it's extreme - but it opens your eyes to the dangerous parts of our healthcare system. And fear can be a good motivator to learn. I try to know as much as I can so that I can make informed decisions.

Anyone else have insurance stories/advice they want to share?

Posted by admin on March 25, 2008 01:52 PM | Permalink

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Here's a recent response I wrote when someone asked about how she could reduce her out-of-pocket drug expenses with her insurance company:

I'm not an expert in this area, but I would try a few things.

First, I would approach my own insurance company and explain to them that most other insurance companies offer this drug on a tier, and see if they are willing to work with me on the cost.

Then, I would go straight to the drug company.  I'm not sure which drug you take specifically, but most big drug companies offer financial assistance for expensive drugs (such as the ABCR drugs).  They want you to be taking their drug, and want to help you find a way to do it.  You have more leverage with them than you think.  For drugs with a very specific target (such as an MS drug), the market to which they are selling is very limited -  which gives us more leverage.

I personally think going to the drug company is more likely to get results.

Another thing to look at is another insurance company.  If your company has an open enrollment every year, take a look at the other options to see if there are better ones.  There is usually a way to reduce the cost of these expensive drugs - I would just try from a few different angles.

Posted by admin on December 2, 2006 03:25 PM | Permalink

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When you have MS in the United States, you must learn about health insurance.  It could save you a lot of money and headaches by just learning the rules.

Much of the information you can get by visiting your health insurance company's website.  They should have a list of medications they will agree to pay for (formulary) as well as doctors who are in their network.  Much depends on what type of plan you have (e.g., PPO, POS, HMO, etc.).

I have had to follow up with my insurance companies many times to get benefits which they initially declined.  They have always been willing to work with me.  One important point is that many insurance companies require prior authorization before you do certain procedures (such as MRIs).  I always check and double-check that the prior authorization has gone through before I have procedures done.  I'm not an expert, but I know enough so I'm aware of what is and what is not covered.  

Some of the treatments for multiple sclerosis cost over $10,000/year.  Learn as much as you can so you can maximize your insurance benefits.  It could save you a lot of money.

Posted by admin on August 24, 2006 02:57 AM | Permalink

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