When Thyroid Patients Need to Fight Health Insurance Companies

Tips on Fighting a Health Insurance Company

When Thyroid Patients Need to Fight Health Insurance Companies
Savvy thyroid patients should know how to deal with health insurance companies. clipart.com

If you're one of the millions of Americans lucky enough to have health insurance, at some point along the way you will need to fight a health insurance company. Even with insurance, most people will face the challenge of an insurance company that denies coverage for particular tests, treatments or medications, even those treatments or medications that your doctor specifically recommends or prescribes for your health or thyroid condition.

Your insurance company may say that you need advance permission or pre-approval before you undergo a particular medical test or treatment, or before you can be prescribed a particular thyroid medication. Even when you get that advance approval, your insurer may turn around and refuse to cover the cost of particular tests, treatments or medications. Refusal to cover medications is frequently a problem for thyroid patients who are prescribed controversial natural desiccated thyroid drugs like Armour or Nature-Throid, or thyroid cancer patients whose physicians recommend use of the drug Thyrogen (thyrotropin alfa), which can be very expensive and is not available in a generic form.

Why do insurers deny coverage, and what can you do about it? Youc an read more about it in this article at About.com's Patient Empowermentn site, titled Why Does My Health Insurer Deny the Care My Doctor Recommends?

Insurers are also known to regularly cover only certain doctors, particular hospitals or laboratories, and deny coverage for others. This can be confusing, but there are reasons why insurers cherry pick their coverage. Find out why some health insurers refuse to pay for some doctors, labs or facilities, in the article: Why Doesn't My Health Insurance Cover the Doctors I Want to See?

Will your insurance cover holistic or alternative treatments - like herbal medicine or acupuncture-- for your thyroid condition and related symptoms? Most don't, actually. There are reasons why insurers refuse to cover anything that is not conventional,you can learn about it in this article: Why Won't Health Insurers Pay for Alternative Medicine or Complementary Therapy?

In some cases, an insurer will deny coverage because your bill was coded with the wrong CPT code. CPT stands for "Current Procedural Terminology," and CPT codes are a complicated system of codes that are assigned to every task and service a medical practitioner provides as part of your treatment. If the whole world of medical codes is like a foreign language, you can learn more about it in this informative article: What Are CPT Codes? Do They Affect Your Healthcare?

CPT codes are not the only codes that can affect whether your insurer pays for or denies your payment. There are Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare, NDC (National Drug Codes), DSM codes used to designated psychiatric illnesses, and many more.

You'll see explanations of all of these codes in a series of informative articles Medical Codes: A Patient's Guide to Medical Codes.

Are you ready to go all the way to fight an insurance company that has denied your claim for legitimate thyroid care, thyroid medications, or other recommended medical tests or treatments your doctor has suggested for you? You can learn more from About.com's Health Insurance Expert, Dr. Michael Bihari, in an article that offers a great deal of excellent advice on Fighting a Health Insurance Claim Denial: Sometimes You Win, and Your Health Has to Pay All or Part of Your Claim.

In the end, even though it seems that the balance of power is weighted toward the insurers, thyroid patients still have every opportunity to be empowered health consumers. Patient Empowerment guide Trisha Torrey has put together excellent advice in her article: The Basics of Being an Empowered Healthcare Consumer. Trisha also has an excellent list of resources in her Savvy Patients' Toolkit online.

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