Insurance FAQ
Use the links below to navigate this list of answers to frequently asked questions.
What if I do not have or cannot afford insurance?
According to the U.S. Census Bureau, approximately 15 percent of Americans do not have health insurance.¹ If you currently do not have health insurance, take a few minutes to review the consumer guide for your state on getting and keeping health insurance. State-specific consumer guides can be found at the Web site of the Georgetown University Health Policy Institute.
Additionally, many drug manufacturers offer financial assistance to patients who otherwise could not afford medications. Patients may be able to obtain free or discounted medications through the manufacturer directly. Contact the drug manufacturer directly first because the manufacturer may be the resource able to provide the fastest service. Contact information for some drug manufacturers can be found in the National Psoriasis Foundation Treatment Guide. You can also contact your local pharmacy. Your pharmacist can provide you with the contact information of the company that makes your prescription medication. A number of organizations also exist to help individuals pay for medications. To view a list of some major drug manufacturers and patient assistance programs, click here.
¹ Source: http://www.census.gov/prod/2003pubs/p60-223.pdf
What if I cannot afford my medication or my co-pay for my medication is too high?
Many pharmaceutical companies offer financial assistance to patients who otherwise could not afford medications. Patients may be able to obtain free or discounted medications through the manufacturer directly. Contact the pharmaceutical company directly first because the manufacturer may be the resource able to provide the fastest service. Contact information for some drug manufacturers can be found in the National Psoriasis Foundation Treatment Guide. You can also contact your local pharmacy. Your pharmacist can provide you with the contact information of the company that makes your prescription medication. A number of organizations also exist to help individuals pay for medications or cover co-pays. To view a list of patient assistance programs, click here.
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What can I do if I have been denied health coverage due to a pre-existing condition?
Sometimes patients are denied coverage by a health insurance company due to a pre-existing condition. If you find yourself in this situation, there is no easy answer but you do have options and certain federal laws are in place to help protect you.
Your rights under federal law: the Health Insurance Portability Act
The Health Insurance Portability Act (HIPAA)—also known as the Kassebaum-Kennedy Act—was designed to protect employees from going uninsured due to a serious health problem as they change from job to job. HIPAA, which went into effect in 1997, also has protections for individuals changing from group policies (one through your employer) to an individual health plan (one you purchase yourself).
Related links:
Learning more about your state's guidelines and state-sponsored programs
In addition to federal laws, each state has its own set of statutes regarding health insurance. To learn more, please contact:
Your state's insurance commission
Information on your state insurance commission can be found at the Web site of the Kaiser Family Foundation.
You have a few options available to you if you feel you have wrongly been denied coverage due to a pre-existing condition, including:
- File a grievance with your health plan and your state's insurance commission.
- Obtain an independent review of your health plan's decision through your state's insurance commission.
- If your health insurance company has violated governing federal and state laws by denying you coverage due a pre-existing condition, you may be able to take legal action against your health plan.
- Obtain alternative coverage. You may be eligible for a state-sponsored program specifically designed to meet the needs of individuals who are denied coverage due to preexisting conditions. Contact your state's insurance commission (see www.kff.org/consumerguide) to learn more.
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What if my doctor recommends a treatment that is not covered by my insurer?
If your doctor prescribes a treatment which is not covered by your insurance, you can either appeal to the insurance company to try to get it covered or request assistance paying for the medication through another source. Many drug manufacturers offer financial assistance to patients who otherwise could not afford medications. Patients may be able to obtain free or discounted medications through the manufacturer directly. Contact the manufacturer first because they may be the resource able to provide the fastest service. Contact information for some drug manufacturers can be found in the National Psoriasis Foundation's Treatment Guide. You can also contact your local pharmacy. Your pharmacist can provide you with the contact information of the company that makes your prescription medication. A number of organizations exist to help individuals pay for medications. To view a list of patient assistance programs, click here.
What if my insurer will not cover the cost of a certain medication or my claim is denied?
Psoriasis patients have the right to appeal a denied claim from their insurance company. Click here for information to help you navigate the appeal process.
I tried appealing, but my insurance company is still denying my claim. What do I do now?
In addition to the internal review of appeals conducted by a health plan, many states also conduct "external reviews" or "independent reviews." Once an individual has exhausted his/her avenues for appeal within the health plan, most appeals are eligible for external review by the state. Specific information and instructions for applying to your state's review program can be found through the Kaiser Family Foundation or the National Association of Insurance Commissioners.
A template letter to send to the state insurance commission can be found here.
What are my rights as a patient?
For more information on your legal rights as a patient, please review the Health Insurance Portability and Accountability Act (HIPAA) information available from the U.S. Department of Health & Human Services.
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