Navigating Insurance… Without Losing Your Mind

Living with three autoimmune diseases and a long history of debilitating migraines, my medical insurance is on speed dial.

Did the medication get approved? Did you receive the pre-authorization? How long does the review process take? Why is insurance recommending something different than my doctor? Shouldn’t the doctor have the final say on which medication I take?

Health insurance shouldn't be this difficult

It goes on and on, and often times around in a circle. At some point, I step back and I think "It shouldn’t be this hard!". It’s adding stress to my life right now and that’s the opposite of what I want when I’m dealing with a health crisis.

But the reality is that we are living with a broken healthcare system.

There have been many positive advancements over the years – research breakthroughs and new medications, as well as enhanced technology for imaging and surgery. There have also been many roadblocks/setbacks. More people are struggling to afford insurance and needing alternatives when they simply can’t make ends meet. Those people who are fortunate enough to have insurance are getting more denials than they are approvals.

My experiences navigating health insurance

Living with a chronic illness, I find myself smack in the middle of this storm. I’ve always been fortunate enough to have insurance – even when it meant selling my home to ensure I would have the coverage I needed.

Yet, even with coverage, I haven’t always received the benefits of having insurance – access to the medication my doctor prescribed when I needed it or getting tests done that I can’t afford because even with insurance they’re astronomically expensive. I realize that I single handedly can’t change the system, but as a patient I need to figure out how to navigate it.

When I feel like I’ve been backed into a corner, I’ve found the most valuable thing for me to do is to shift my mindset. Sounds woo-woo, I know, but if I can’t change the situation, I have to change how I experience it. I take deep breath to gather my thoughts and emotions, so I can respond with reasoning versus emotions. I speak from experience in saying that remaining calm and delivering the facts is far better received!

Tips for talking to the insurance company

Speaking of facts, let’s talk a minute about the reality of these conversations. Talking to insurance companies can feel like you’re speaking another language.

With no real understanding of how the system actually works, I’m having to plead my case with little knowledge of the lingo. So, I take notes – I log the time of each call, the representative’s name and the key takeaways. I also ask them to explain anything I don’t understand and jot down the meaning of key terms. I’ve been surprised how much it helps with ongoing issues.I’m better educated and therefore more prepared for the next call which ideally moves me closer to the resolution.

At the end of the day, there is no “easy” way to navigate insurance, but they are ways to make it less stressful. For me that starts with managing my emotions so I can focus on the facts, being persistent with my desired outcome, and ultimately trusting the process. This is obviously just based on my own personal experiences, but I know I’m not alone in this struggle.

What tips can you share to someone who needs some guidance or inspiration on how to best manage their insurance struggles?