New Year, New Insurance, Same Headache

In October of 2019, I received a letter in the mail indicating that my husband's employer was changing insurance providers for 2020.

As a Crohn’s disease patient, this letter made me nervous. I knew that meant ensuring my current providers remained in-network, receiving new pre-authorizations for my infusions and regular prescription medications, new policies, and the huge potential for new headaches.

We’re less than a month into the new year, and I’ve already spent countless hours on the phone & wasted countless tears on trying to get my health insurance to work for me. To clarify, that is “convincing” the new insurance provider to provide coverage for the things that I need to maintain my health, manage my Crohn’s disease, and prevent further disease damage, active flares, or lengthy hospital stays.

Let me share with you two infuriating moments in this process.

2019 insurance denials

I wrote recently about my cringe-worthy adventures in health insurance. Although NOTHING had changed with my 2019 insurance and nothing was added or subtracted or modified, I experienced denial of several claims without reason on the electronic explanations of benefits. Of course, that set off widespread panic in my chest and immediately had me dialing the current insurance provider. I was bounced around between several representatives and had to repeat my story, my questions, and my information more times than I wanted to count, but what I identified was INFURIATING.

In the same way that I received a letter in the mail, my current insurance provider was notified by my husband's company that we’d be switching to a new insurance provider on 1/1. Instead of listening to that, or reaching out to the members they were insuring for verification, they decided to decline ALL claims that came in for the remainder of 2019 until I as the patient called them and verified I still only had one form of insurance coverage.

WHY? How does this make any logical sense? I have no idea, but I spent a good part of December around the holidays calling and begging my providers to resubmit my claims for re-processing. This caused me frustration and anxiety - things I did not need to amplify as an IBD patient.

2020 authorizations

As I’ve shared before, I receive IV Remicade every six weeks to manage my Crohn’s disease. My infusion center is incredible and their verification and billing department helps me manage much of my insurance communications surrounding my medication. I was scheduled for an infusion right after the New Year, and the center called to let me know my new 2020 insurance provider would not even speak to them to verify my coverage until I was active on their plan (meaning on/after 1/1/20). This was obviously anxiety-provoking and incredibly inefficient in my opinion.

My infusion center recommended I come in and get my infusion a few days early, on New Year's Eve, in fact, just in case getting new insurance approval took time - they didn’t want my infusion delayed.

And thank goodness I did!

The insurance issues I've been dealing with

The last three weeks have consisted of so many back and forth phone calls, with the insurance company telling me something different than the infusion center, and visa versa.

• First, they told me the infusion center was out of network, but that I could fill out a Transfer of Care form.
• Then, I was told the form was approved, but the infusion center was told that it wasn’t.
• Next, they approved only one infusion, stating prior-authorization would be needed before EVERY infusion. EVERY six weeks. This was insane. And infuriating.
• The next phone call indicated that I actually had approval for one unit, which was 90 days time, regardless of how many infusions I got in that time (um, what? This is unlike anything any previous insurance company has told me).
•  My infusion center was confused, so they called and again, and were then told that my drug coverage didn’t change, so as long as the center was approved as in-network, I didn’t need prior authorization on medication dose/frequency.

This is when the infusion center gave up. And told me that they documented that phone call. And that we would proceed as normal, and if my claims are denied, we’ll appeal.

But WHY? Why is it THIS hard to get straightforward information from the insurance company about the medication and treatments I need to live?

Suggestions for an insurance change

After managing the stress and frustration that has come from this entire ordeal, I wanted to provide my suggestions for anyone going through an insurance change:

1. Maintain a list of your current providers. Ensure they are “in-network” immediately with your insurance provider.
2. Maintain a list of your current medications, where your prescriptions are filled, if you use specialty pharmacies and/or infusion centers. Print-out your current benefits and compare them against your new benefits.
3. Highlight any differences and call the new insurance company to ask questions.
4. On that note, write out your questions before you call. Those calls are often frustrating and you may get transferred several times. It’s best to help yourself stay calm and focused.
5. If the answers you receive are confusing, call back and ask again.
6. Ask your primary care physician or GI doctor if they have a nurse or patient advocate that can help you understand the new benefits and get set up for success.

If you’ve developed coping strategies to make insurance transitions easier, I’d love to hear below!