Navigating Insurance Changes at the Start of the New Year with MS

As we ring in the new year, many of us are trying to figure out the details of a new insurance plan. Or maybe you have the same insurance plan from last year, but even after a year experience with it under your belt, you’re still overwhelmed and confused by the nuances of it.

I want to share what I've learned

First, let me say that I’m extremely grateful to have health insurance. I’ve had years that it was paid for by an employer, as well as years that I had to pay for it fully out of pocket. The reality is both were expensive and fairly stressful. But I do want to acknowledge, that having insurance is a blessing that should not be overlooked.

However, I do want to help make this “blessing” a little less painful of an experience for us to use. I am not an insurance expert; I am simply your fellow MS sister who has spent countless hours on the phone with the insurance company over the years for various health needs. I want to share what I’ve learned in hopes that it could possibly help you as well.

Because this is all based on my own personal experience, it’s by no means a comprehensive list. So, I would love to hear from you in the comments of this article what tips you might have for navigating insurance. And of course, if you need a space to just vent for a minute about the struggles of insurance while living with MS, we welcome that, too. We’re right alongside you with the good, the bad, and the ugly realities of living with multiple sclerosis.

Practical tips for understanding insurance and MS

Let's dive into some practical tips to make this process a little easier on us all.

New year, new insurance

If you find yourself with new insurance this year, it can feel overwhelming. Here are some steps to help break it down.

Understand your plan: start by understanding the basics (deductibles, copayments, out-of-pocket max, do you have out-of-network benefits, etc.), as well as what is most relevant to you right now. Are your specific doctors covered, is there a preferred lab or imaging center that you need to start using for lower costs? I like to have this written down all in one area.

If you do well with online portals, you can also ask if the insurance company offers an online portal or even an app that will help you to track approvals, bills, etc.

Review medication coverage: check if your MS medications are covered under the new plan. Sometimes, insurance changes can affect drug coverage, so make sure you're aware of any changes. I’ve experienced this firsthand; with the change of a new insurance plan, I had to go through another approval process. It was like starting all over again, but it was part of the process.

Copayment assistance programs: many pharmaceutical companies offer copayment assistance programs to help offset the cost of MS medications. This may be a perk of a new plan that you don’t want to miss out on. They can take a little leg work at first, but ultimately are worth the effort. Research these programs and see if you're eligible.

Ongoing approval struggles

Now, if you have the same insurance as last year and are feeling stuck with the same ongoing struggles with insurance approvals, you're not alone. I wish I had a magic wand to resolve all of these hurdles, but here are a few tips to just help set you up for success as best as possible.

Keep records: I am meticulous when it comes to my records of interactions with insurance, including phone calls, emails, and letters. This has helped me so much when I’m able to reference specific conversations – including the date, time and the name of the representative that I spoke with. Take good notes. This can be crucial when disputing denials.

Stay persistent: don't be discouraged by initial denials. Insurance companies often deny claims as a standard procedure. If you believe a service or medication is medically necessary, be persistent in appealing the decision.

Appeal process: ask questions about the appeal process. Understanding this is really helpful. Follow it as they explain, providing all requested information and documentation to support your case. I personally found it really helpful to go for walks or do some type of stress management after getting off of stressful phone calls.

Now it’s your turn

Whether you're dealing with new insurance changes or ongoing approval struggles, remember that you have this community here of people who “get it.” You are not on this journey alone.

As I’ve shared earlier, I would love to hear your experience, struggles, and tips for navigating insurance. Please share in the comments below.