Denied: What Can I Do When Insurance Won’t Cover the Treatment or Medication My Doctor Suggests?
Posted by Diana-Lee—January 12th, 2011

Patients with chronic conditions like migraine disease have been through this a zillion times: Your doctor has suggested a procedure or medication, but your insurance company says they won’t pay for it. It’s an incredibly frustrating situation to find yourself in, but what can you do? You might be tempted to find out the cost and try to pay for it yourself, but is there something else to try first? Yes, there is. Here’s what you need to know.

Appeal the Insurance Company’s Decision

Your doctor and his/her staff can help you appeal an insurance denial. By demonstrating the medical necessity of the proposed procedure, treatment or medication your doctor may be able to convince your insurance company they are obligated to pay for the cost of it. The request must be made in writing. Luckily this is a process doctors’ offices are intimately familiar with and most of them will do the work for you as a courtesy. If they don’t offer to initiate the paperwork for you, just ask them about it and offer your assistance to make it as easy as possible for them.

Negotiate Your Cost

Sometimes insurance companies negotiate better prices for their customers, leaving you to pay a higher cost if you pay out of your own pocket. That seems unfair, right? As individuals we don’t have the same negotiating power as a big group. Fortunately sometimes if you ask they will honor the group price for little old you. Maybe they won’t, but ask before you make arrangements for the treatment or procedure. The worst thing that can happen is they say no. It’s worth a shot.

Consider Alternatives

There are often generic alternatives to name brand prescription drugs that your insurance company will be more inclined to cover. While some of us have already been there and back with the generic medications available to us, sometimes doctors will suggest a name brand medication first. If you find yourself in this situation be honest with your doctor about your financial concerns and initiate an open discussion about more affordable options you could try before shilling out hard to come by money for a brand name drug.

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About Diana-Lee

Diana Lee is a blogger, lawyer & health advocate who's been disabled by Chronic Migraine. She's passionate about educating patients & combating stigma

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