20 posts tagged “2016-2017 Team of Advisors”

Team of Advisors member Kimberly shares part two of her insurance series

Posted September 20th, 2017 by

 

Kimberly (firefly84) is part of the PatientsLikeMe 2016-2017 Team of Advisors and is living with autonomic neuropathy, a rare disease which forced an end to her career as a Registered Nurse. In part 1 of her insurance series, she tells the story of how eight of her doctors became out-of-network overnight, and how she navigated the system to replace those providers. In part 2, she shares tips and insights into what to know when dealing with insurance companies, what kind of documents you should take note of and how to understand your pharmacy benefits. Here’s what she shared…

 

Most of you have probably played the game “telephone” when you were younger. The first person whispers something to the next and it goes down the line of people until the last person says what they were told. 99% of the time, the result was absolutely nothing related to the original statement. Things got misconstrued, wording got changed, and as a result it was totally wrong. Well the same goes for health insurance and healthcare in general. The saying, “If it isn’t documented, it didn’t happen,” is used all the time.

Unlocking good habits

Documentation is the key to healthcare. There are many times when we speak to someone who passes that message along to another person, and your original question has likely been reworded in some form. If you don’t remember anything else from this blog, here is what I want to plant in your head: Document! How many times have you called a doctor’s office or insurance company, had a conversation and then hung up the phone without giving it a second thought? How many times have you taken notes during conversations or written a summary afterwards regarding the content? My guess for many of us would be zero, zip, zilch, nada! You’ve always assumed that the information that was passed along would be correct and that whoever was answering your questions was documenting everything you said.

Start making it a habit of keeping a notebook for your healthcare conversations. That way if there is ever a question of what was discussed, you can refer back to it. If possible, use patient portals if they are available through your doctor or insurance company. Most, if not all of them have messaging features, which is a simple way to ensure things are documented. My practice has always been to attempt to send messages for non-urgent matters. This can also be used for evidence if anything becomes a legal issue.

Knowing your coverage inside and out

No matter what insurance you have, it is essential to know what doctors and facilities are covered. If you have private or employer-based insurance, who is in your network? Are there differences in your in-network vs. out-of-network coverage?

A handy place to find this information is on your insurance company’s website. Most companies have a link that lets you search for doctors and facilities. Your insurance will have your PCP (primary care physician) listed already – make sure that it is correct and update it if there is a change.

Do you remember the pile of paperwork that you received when you got your current insurance? Did you read it? I mean REALLY read it! If you’re like many consumers, you probably skimmed through your Summary of Benefits and were able to see a brief overview of what your deductible, copay, premiums, and out-of-pocket maximum amount were. It also described the difference between coverage for in and out-of-network coverage.

The Certificate of Coverage is going to be your “bible,” if you will. It is the 70+ page document that goes into every detail you ever wanted to know about your coverage. This is a document that I highly recommend you read. If you ever have doubts or questions about anything, this is where the fine print is at. It also will address how to file an appeal or grievance.

Taking a closer look at the types of insurance

Maybe it’s time to look for something more affordable or perhaps you are just coming off someone else’s plan. No matter the circumstances, insurance is something that can be very confusing. Premiums, deductibles, copays, blah, blah, blah. What does it mean? That’s what I can imagine going through your head. Brace yourself for a tidal wave of information.

If you’re wondering what the different types of insurance are, you’re in luck. It’s time for a bare necessities lesson (minus the singing and dancing). Check out this handy one page I wrote that shows the types of public and private insurance available.

Understanding your pharmacy options

Often there will be a Pharmacy Rider, which will list the tiers or classifications of medications for coverage. A rule of thumb is that a generic drug is always less expensive than a brand name. Some patients are unable to tolerate generics or experience a different response than with the brand name, if that’s the case you can ask your provider to file a prior authorization form with your insurance company showing you’ve tried generic alternatives of the drug which have not had the desired effect, and you’ll need to be prescribed the brand name version only. Once again, this information can usually be found in the certificate of coverage or by simply calling customer service.

In addition to your pharmacy coverage, there are many programs available for patients with private or employer-based insurance. Almost all pharmaceutical companies have financial assistance available or will offer copay cards for newer medications. This is the case very frequently for injectable medications.

Also, don’t hesitate to do an internet search. There are a lot of free drug discount cards available. However, many of them cannot be used in conjunction with insurance. That is a detail that you will have to clarify.

I truly hope that this blog has been helpful. There are so many different things that go on within a single policy for one patient that it can be overwhelming. Always ask if there is ever doubt, and DOCUMENT. Don’t play the telephone game!

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5 tips for practicing self-care when your chronic illness is trying to take over

Posted August 14th, 2017 by

As a woman with bipolar disorder I and PTSD, I can pretty safely say that no two days are the same. There are days when the world is sunshine and roses; life is grand! Then there are days when the inside of my brain is trying to run the show without me, and it’s leaving a trail of destruction in its wake. There are floundering relationships, self-harm incidents, and half-hatched big plans laying strewn about, and I stand in the middle of it all, trying very hard not to let the illness win.

When I can really stand back and take stock of things, I find that self-care is paramount to my feeling better, or simply not getting worse. The following are some of my “go-to” self-care strategies.

1. Coloring. I know, I know. You’re already rolling your eyes at the screen, wondering what the heck I’m even talking about. But coloring has turned out to be a Zen activity in my life. My manias are not euphoric, but angry and aggressive, and I have found the act of coloring to bring me down in the moment.

It’s also extremely helpful with my anxiety and PTSD symptoms. We’re lucky that the adult coloring movement is upon us, so you can go anywhere and find books and pencils and markers for very little money.

2. Singing. This strategy is actually backed by science. More and more studies show that the act of singing (in the shower, in the car, on a stage) helps to bring a person calm and joy. Non-judgment is the key: find an album or song list you like (vinyl or online), throw it on, and start singing. It can be of any genre of music, any artist, any arrangement. All that matters is that you sing with abandon!

3. Massage. This is a once-in-awhile self-care treat for me. If I had the money, I’d get a massage every week. But I don’t, so I try to do this for myself once every few months. Massage has been used as a relaxation and health treatment for thousands of years, and there are myriad reasons why — but the bottom line is, it makes you feel good! I know many people with chronic illness of all kinds who make sure they put time aside for massage on a regular basis.

4. Journaling… outside. Anyone who’s been treated for a chronic illness for a while probably wants to scream every time someone says “Have you tried journaling?” No, I’ve never heard of this. What is it? Ugh.

All sarcasm aside, though, journaling in the outdoors when I can, or if I’m really not feeling well, has been incredibly helpful for me. The outdoors make you feel like you’re a part of something more, if you want to, or that you’re the only person in the world, if you want to. It’s really all about how you want to take the best care of yourself at that time.

Also, just like in coloring, the actual physical act of writing can help to bring calm and focus. Write a journal entry, write a thank you note to a friend, or write your grocery list for next week. Content matters less than the fact that you’re writing for yourself in the great outdoors. Put a lawn chair out in the backyard, find a nice park with lovely-smelling flowers, or float in your pool with a trusty notebook and pen! (If you’re from the Boston area like me, I’d suggest this activity be taken indoors December-March, unless you really like snow.)

5. An ingestible treat. Self-care is really about utilizing the five senses in an attempt to make you feel better, or at least to bring you to a more manageable spot until you can talk with a doctor or therapist. I have a short list of things that smell and taste good that I make myself (or ask for). Really good coffee or a chai latte are at the top of the list. Being able to hold a warm cup, smell something wonderful, and then take time to taste that wonderful thing involves three senses in a matter of seconds.

These are just a few tools that anyone can use to help make things a little better in the moment, or to be consistently good to oneself. Sometimes one tool on its own is enough, sometimes a few need to be combined. I have a little list on my refrigerator so that when things get bad, I have it in front of me and can start caring for myself.

What’s on your list? How might you practice self-care today?

On PatientsLikeMe

Thousands of members are sharing what helps them manage their mental health and other conditions – from coloring and journaling and to massage and outdoor time. Join today to learn more about self-care and treatments!

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