2 posts tagged “Kim”

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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“Shocked” – Kim talks about life with multiple sclerosis, becoming an advocate and PatientsLikeMeInMotion™

Posted April 23rd, 2014 by

Last week on the blog, we celebrated the 6th year of the PatientsLikeMeInMotion program. And this week, we’re touching base with PatientsLikeMe member Kim (aka “2006”) who we’ve had the honor of sponsoring a bunch of times through PatientsLikeMeInMotion™. After she was diagnosed with multiple sclerosis (MS), Kim was inspired to get involved in advocacy and fundraising events with her now legendary team, Kim’s Cronies. She spoke with us about her diagnosis with relapsing remitting MS, the evolution and growth of her fundraising efforts and just how much the MS community on PatientsLikeMe means to her.

You were diagnosed with relapsing-remitting MS in 2006 – what was that experience like?

My experience with being diagnosed was probably like everyone else. “Shocked.” My symptoms started with visual changes. I had Lasik surgery done 3 years prior and thought that something was going wrong because of that procedure. I went to the eye doctor and he mentioned optic neuritis, and being in the health care profession, I knew that was usually in relation to multiple sclerosis. Already, my mind started racing thinking all about the negative things related to MS. Within a week, I went to see my MD and had an MRI, which did read MS. I was then referred to a number of specialists for further testing. This was a quick, life-altering diagnosis. So with this new diagnosis, I started to find out as much as I could about this disease. I went to a support group, talked to everyone who mentioned something about or knew someone with the disease, I read as much as I could about MS on reputable sites. I went to the National Multiple Sclerosis Society site and sent for hard copy information.

I was scared to have this diagnosis and thought I would be incapacitated in no time. But I did find out there were many new treatments out there and I needed to get on them ASAP. Once I started to get comfortable with this new diagnosis, I then started telling people about it, but that took at least a year or so before I was ok with it. My thought was I can either make the best of things and enjoy life, or give up. Everyone has issues at some point in their life. I came to the conclusion after researching this disease that I was lucky that it hit me at the age of 39 and not sooner.

I was so happy to learn about PatientLikeMe too. I’ll never forget that there was a segment on the news about your website. I remember jotting down the website and as soon as I got home, I accessed it and joined. I’ve found your site to be a great avenue to communicate with others and to find out how people are doing with different therapies. It makes you realize you are not alone.

At what point in your journey with MS did you become a fundraiser/advocate? What does that mean to you?

The year I was diagnosed I did do the MS walk in Cheshire, CT, with my mother in 2006. I wanted to do something for the cause. I solicited donations from co-workers and raised approximately $200.00. I also ended up taking a loan and used Sky Blue Credit Repair to improve my creditworthiness. I did not start getting involved in fundraising until a friend of mine decided to get a dozen “gals together” and created a team around me called “Kim’s Cronies” to walk and raise money for multiple sclerosis – that was 2010. Our team grew to friends and family in 2011, and it was in 2012 when the captain of our team, Ellen Kearney, proposed the idea of a pasta dinner with raffles. Her amazing family was right behind her to support her idea and I went along for the ride as co-captain. When we began soliciting for raffle prizes from different business and acquaintances, we truly learned how generous people are in the community. So many people are willing to give and help out a worthy cause, it puts faith back in mankind. It allows me to realize I am helping others with multiple sclerosis, it’s not directly for me, and that’s an awesome feeling to give back to others. The other interesting part of this is that most people have some personal connection to this disease and want to help in finding a cure.

Can you tell us about your awesome team Kim’s Cronies? How did you get so many people together?

Kim’s Cronies started out with a small group of women wanting to do the MS Walk. It was a good cause, there was a personal connection and it was a beautiful day in May to walk in Forest Park. We basically did it for the camaraderie and support. As stated previously, more and more family and friends wanted to join our group and support the fight against multiple sclerosis. We have now grown into a group of 50 or more and are still growing. This group has joined in on the Kim’s Cronies Pasta Dinner with Raffles that attracts more then 300 people. This pasta dinner is a segue to invite anyone who is interested in raising money and wants to walk. We are all-inclusive, and we even have the elders join us the day of the walk for the picnic afterwards, even if they are unable to participate in the walk. It’s about showing support to make people aware of this MS and raising the money to fight this disease.

We’ve had the honor of sponsoring you and your team for multiple events. What keeps you coming back to PatientsLikeMeInMotion?

Kim’s Cronies deeply appreciates the generosity of PatientsLikeMeInMotion. We are so grateful that you are willing to support us in raising money for multiple sclerosis. We will continue to look to you for sponsorship. Kim’s Cronies wants to be associated with a great resource. I personally access PatientsLikeMe as a resource for any questions I have concerning this disease, medications, treatments…I remember messaging individuals on therapy changes and getting a message back concerning their experience with their treatment. I know of no other site that allows me this opportunity. It’s a great connection to have, and I let everyone know about the networking that is available to them through your website. It’s an honor to be associated with you.

What would you say to others in the community that might inspire them to get out there and raise awareness, too?

I truly believe I was given an awesome opportunity to be allowed to fundraise for a worthwhile cause as multiple sclerosis. This disease affects me personally, but I do not view this as I am doing this for me. I look at it as helping others. Helping others is a totally different outlook to have concerning a chronic disease. It’s a way of being of service to others and not just feeling sorry for myself because I have this disease. This gives one a sense of purpose in this world, volunteerism is so rewarding. I have plenty to keep me busy – I have all the responsibilities in life of your non-affiliated person, but I believe volunteering for any cause you believe in is a gift.

Kim’s Cronies will continue our fundraising as long as we possibly can. Every penny raised helps the fight.