Tips for working with your health plan
1. Contact a claims representative at your health plan. A claims representative can also advocate for your case.
2. Don't get angry, get involved. Be persistent and polite because you deserve the medically necessary treatment prescribed by your doctor.
3. Be ready to educate. Assume the personnel you contact at your health plan may have never heard of psoriasis or psoriatic arthritis.
4. Keep good records.Take notes on all phone calls, letters and contacts with your doctor and health plan. Also, keep records of the different medications you have tried.
5. Notify the health plan of your intent to appeal their decision. If your claim for treatment is denied, send the health plan a letter in writing to let them know that you will be appealing their decision. Request a free copy of their medical policy for the treatment of psoriasis. Ask them to accept information from the National Psoriasis Foundation and your doctor as part of your appeal and fill out release of information forms if required.
6. Contact the National Psoriasis Foundation. We may be able to provide a supportive letter on your behalf. It would be helpful for us to see the denial letter from your health plan, first.
7. Send a copy of your health plan’s medical policy for the treatment of psoriasis and psoriatic arthritis to the National Psoriasis Foundation. The information you provide will help us determine whether or not your health plan’s policies are meeting the needs of psoriasis patients.
8. Notify your department of human resources (HR). If you receive health insurance through work, your employer purchased the plan on your behalf. Therefore, your employer is a customer of the health plan, so enlisting the help of your HR department, or whoever is in charge of health benefits, can be helpful for your case. Your employer should understand the effect psoriasis has on your personal and work life and that the health benefits offered at work do not allow you to access the medication or treatment you need.
9. Contact the company that manufactures the treatment in question. Many drug companies and phototherapy manufacturers have staff that can help with your insurance problems.
10. Contact your state insurance commission. 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 appealwithin the health plan, most appeals are eligible for external review by the state. Conducted by an individual or a panel who is not part of the health plan, an external review resolves disputes between patients and their health plans. Contact information for your state insurance commission can be found by visiting the Kaiser Family Foundation Web siteor the National Association of Insurance Commissioners.
11. Refer to the Access Action Guide: getting the psoriasis treatment you need. This booklet is a consumer guide to insurance coverage and includes tips, tools and resources for patients to better understand their health plan, appeal health plan denials and take appeals to the next level, find financial assistance and more.
12. DO NOT GIVE UP. It may take a little time, but taking action with your health plan is worth it. Time after time, we see that patients who stick with the appeal process see results. The Psoriasis Foundation, your doctor and the drug manufacturer can help. Use the resources available to you and challenge your health plan’s decision when your doctor has prescribed a medically necessary treatment – it’s your right to do so!–and in the end, you will greatly increase your chances of getting the treatment that you need.
For information or assistance with any of the above tips please contact, advocacy@psoriasis.org or call 800.723.9166 x550.
Some of the links above will take you off the Psoriasis Foundation Web site. The Psoriasis Foundation does not endorse or accept any responsibility for the content of external Web sites. Review complete terms of use.
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