Today’s health care landscape can be difficult to navigate. Medicine costs can be high, insurance policies can be confusing and specific terminology can be tricky to understand.
At NPF’s Patient Navigation Center, we teach people living with psoriatic disease how to navigate all aspects of the insurance world.
From enrolling in the health care marketplace to finding financial assistance programs, we show people with psoriasis and psoriatic arthritis how to tap into the many resources available to them to get the best care.
The key is to become an advocate for your own health and well-being. Here are four steps you can take to begin navigating the insurance world:
1. Familiarize yourself with key insurance terminology.
To navigate the insurance landscape, you must have a basic understanding of the language used to describe health plans and payments.
Regardless of your specific insurance type, familiarize yourself with the following key words that describe coverage and cost:
● A premium is the dollar amount that either you or your employer pays each month for health insurance coverage. Depending on your insurance plan, you often have to pay other costs for health care services, including a deductible and copayments.
● A deductible is the dollar amount you must pay each year for covered medical services before your insurance company starts paying.
● A copay (or copayment) is one of the ways you share medical costs with your insurance provider. When a medical service is received, you pay a portion of the cost, and your insurance company pays the remainder of the cost.
● Coinsurance is when you pay a percentage of the cost of the treatment, rather than a fixed dollar amount or copayment.
2. Understand how to use your insurance coverage.
Now that you’ve learned some key language, it’s important to understand what your insurance coverage looks like in your day-to-day life.
For example, figure out which local providers are in-network and which are out-of-network. Review the list of treatments your insurance plan covers (called a formulary). If you don’t know where to find this information or have questions, contact the Patient Navigation Center. We’ll walk you through any insurance-related document.
3. Keep a detailed record of your treatment.
In many states, patients are required to try a series of more cost-effective medicines before their insurance company will pay for a new treatment. This practice is called “step therapy” because patients have to try – and fail – medicines before “stepping up” to other drugs.
If you encounter a barrier to accessing care due to step therapy, you and your health care provider will need to provide a comprehensive account of your medical history.
To make it easier to track your history, keep an account of your providers, treatments and your history of care. You will need this information to 1) access the treatment that you and your doctor think is best, and 2) appeal any insurance denials.
4. Explore all the avenues you have to access treatment.
There are many programs that provide financial assistance to help with accessing health care and treatment for psoriatic disease. Some of these services include patient assistance programs, financial assistance resource organizations, copay help programs and state resources, including free and low-cost clinics and drug assistance programs.
At the Patient Navigation Center, we understand the options available to help you get treatment. For example, if your insurance company denies coverage of a new medicine prescribed by your provider, we can help you file an exception.
If your insurance plan changes and you lose coverage for your current treatment, we can help you get back on that treatment.
We can even help if you’re uninsured. Regardless of your insurance issue, you can turn to us to help navigate available resources.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.