Please note our 2023 holiday schedule will be as follows. Our office will be closed Monday, December 25, 2023 through Monday, January 1, 2024 and will reopen on Tuesday, January 2, 2024, at 8:30 am EST.✕
Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides case management services and financial aid to Americans with chronic, life threatening and debilitating illnesses.
There are many life events that cause people to switch their healthcare coverage. No matter the reason, it’s always a good idea to pay close attention to the details of a new plan when changing your insurance policy. It is especially critical if you’ve been diagnosed with a serious illness, as the cost implications can be staggering.
The first thing you’ll want to do is review your options relatively quickly to avoid any gaps in coverage. If you’ve lost your job or were laid off, there are protections for you in place so you aren’t without insurance. For example, government protections like COBRA allow you to stay on your old plan for an increased cost up to 18-36 months. There are also short-term insurance options that allow you to enter your information and cost-compare coverage alternatives in your area.
Another coverage barrier you’ll want to keep an eye on is ensuring your doctor is in your covered network. Along those same lines, keep in mind that even if your in-network doctor refers you to a specialist, that doesn’t mean the specialist is also in-network. One way to double check is by calling your insurance company or visiting their site online. You can also call the medical provider’s billing office with your insurance information before scheduling an appointment to ensure the service is covered.
Be sure to take a look at your new plan’s approved medication list, commonly referred to as a drug formulary. A drug formulary is a list of prescription drugs that are preferred under your health plan and are often offered at a reduced rate. Most insurance plans have a list of their approved drug formularies available for viewing online. If you find that your medication is not covered under your plan, don’t fret! You have several options.
Ask your doctor if there is an alternate medication, such as a generic you can take.
If substituting the medication is not an option for you, request a prior-authorization from your physician stating why you need the medication for your condition.
If you ask for an exception and they deny your request, you have the right to appeal their decision.
By paying attention to your plan details and being your own advocate, you’ll stay more informed and the risk of unexpected costs to you will be greatly reduced. Be sure to save your insurance company’s contact information, so that you may reach out to them if you have questions about what is covered under your new plan.