The Daunting Prospect of Changing Insurance
I live with 2 autoimmune diseases - rheumatoid arthritis and Crohn’s disease. In order to manage both conditions, I take biologic medication via IV every 5 weeks, alongside several oral prescriptions.
I receive care and advice from multiple specialists alongside my primary care physician: a rheumatologist, gastroenterologist, psychiatrist, endocrinologist, and an OB/GYN.
I utilize a traditional pharmacy near my house for one-off and as-needed prescriptions, a mail-in pharmacy for prescriptions I take regularly and fill in 90-day supplies, and a specialty pharmacy through which I receive my biologic.
Medically - my health is mostly managed. When it comes to insurance - I’m a complicated hot mess.
This time, the insurance switch was not straightforward
Typically, without any major life events (ie: moves, job changes, job losses, etc), insurance changes only at the beginning of a new calendar year.
I know to see all of my doctors and renew all of my prescriptions in December, and I know that I need a new prior authorization for medications like my biologic come the beginning of January. It’s a pain, but fairly straightforward.
Different health insurance with a new employer
What I was forced to navigate this past month was more than a pain: It was a gigantic stressor, and it was not at all in the slightest straightforward, as illustrated by the raging migraine and insomnia I’ve struggled with over the past few weeks.
For the last few years, my health insurance has been covered by my husband's employer. They switched insurance carriers in 2019, and I was disappointed by the change (in costs, in providers, in everything) but we still had relatively good coverage overall.
After more than a decade with the same company, my husband decided to change jobs. This was something that, overall, we were excited about, but it meant a change in insurance - during the last quarter of the year.
This was the first blow.
My deductible and out-of-pocket max
I’d met my deductible and out-of-pocket max early on in 2021, so starting over in October was less than ideal, especially since those same amounts would be re-set in January 2022.
As soon as I found out this would be the case, I tried to mentally begin stashing away the money I’d need to cover the new, short-term deductible and out-of-pocket max for the end of 2021.
Uninsured for 2 weeks
In addition, we ended up without access to insurance for 2 weeks, even though we were technically covered. One insurance plan ended mid-month instead of the end. And, while the other 1 began mid-month, we didn’t receive plan information or membership cards for 2 weeks after my husband began work.
This meant that during this time, any care I sought would be paid out-of-pocket and then would require a fight to receive reimbursement by the new insurance company once everything settled.
3 lessons on changing insurance carriers
This complicated transition, while ultimately painful, taught me a few very important things:
1. As a chronic illness patient, it's critical to be extremely organized:
- Names, addresses, phone numbers, and fax numbers of every provider I see and every pharmacy I utilize, as well as notes on what insurance carriers they take/are included in-network for
- Names, doses, frequencies, quantities, and cost of every medication I take
2. Communication is critical. During this period of transition, I completed close to 100 phone calls over a few weeks' time across the old insurance and the new one, the prescription benefits service, pharmacies, and the doctors' offices.
3. Be kind to yourself. This is frustrating as all heck, and almost every person you speak with will ask you questions that you either have already answered, or don't know the answer to, and inevitably you'll get hung up on more than once. So, take a few deep breaths and remember that you're doing the best you can with what you've got.
If you've ever had to navigate a transition like this - what did you do to stay sane and organized? I have to confess - I've been a list-making, spreadsheet-creating patient in overdrive this season.
Do you or someone you know have gout? (Select all the apply)