If you're one of the millions of Americans lucky enough to have health insurance, at some point along the way you will need to fight a health insurance company. Even with insurance, most people will face the challenge of an insurance company that denies coverage for particular tests, treatments or medications, even those your doctor recommends or prescribes for your thyroid condition.
Your insurance company may say that you need advance permission before you undergo a particular medical test or treatment, or before you can be prescribed a particular thyroid medication. Even when you get advance approval, your insurer may turn around and refuse to cover the cost of particular tests, treatments or medications. Refusal to cover medications is frequently a problem for thyroid patients who are prescribed controversial natural desiccated thyroid drugs, or thyroid cancer patients whose physicians recommend use of the drug Thyrogen (thyrotropin alfa), which can be very expensive and is not available in a generic form.
Why do insurers deny coverage, and what can you do about it? Patient Empowerment guide Trisha Torrey explains, in Why Does My Health Insurer Deny the Care My Doctor Recommends?
Insurers are also known to regularly cover only certain doctors, hospitals or laboratories, and not others. Find out why some health insurers refuse to pay for some doctors, labs or facilities, in Why Doesn't My Health Insurance Cover the Doctors I Want to See?
Will insurance cover holistic, or alternative treatments - like herbal medicine or acupuncture-- for your thyroid condition and related symptoms? Most don't, actually. Here's why: Why Won't Health Insurers Pay for Alternative Medicine or Complementary Therapy?
In some cases, an insurer will deny coverage because your bill was coded with the wrong CPT code. CPT stands for "Current Procedural Terminology," and CPT codes are codes that are assigned to every task and service a medical practitioner provides. If the whole world of medical codes is like a foreign language, Trisha Torrey has put together an article to explain it all: What Are CPT Codes? Do They Affect Your Healthcare?
CPT codes are not the only codes that can affect whether your insurer pays for or denies your payment. There are Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare, NDC (National Drug Codes), DSM-IV-TR codes for psychiatric illnesses, and more. Trisha Torrey explains them all in her series of informative articles Medical Codes: A Patient's Guide to Medical Codes.
Are you ready to go all the way to fight an insurance company that has denied your claim for thyroid care or other medical tests or treatment? About.com's Health Insurance Guide, Dr. Michael Bihari, has excellent advice on Fighting a Health Insurance Claim Denial: Sometimes You Win, and Your Health Has to Pay All or Part of Your Claim.
In the end, even though it seems that the balance of power is weighted toward the insurers, thyroid patients still have every opportunity to be empowered health consumers. Patient Empowerment guide Trisha Torrey has put together excellent advice in her article: The Basics of Being an Empowered Healthcare Consumer. Trisha also has an excellent list of resources in her Savvy Patients' Toolkit online.