But there are some other things you should know about that are downright scary.  For example:

 

If you are on disability and eligible for Medicare and do not elect Medicare Part B because you already have commercial insurance through your job (some jobs leave you on the rolls as an active employee while out on disability) or a spouse, you can end up in some very hot water if you or your spouse is laid off.  If you or your spouse is in a large group plan, as long as you or your spouse is an active employee, Medicare is secondary to your commercial insurance.  But if you or your spouse no longer is an active employee, Medicare becomes primary, and your commercial insurance plan may require that you elect Medicare Part B.  If you didn't elect Part B when you became eligible, you will pay penalties and perhaps have to wait for your Part B benefit to take effect when you enroll late.  But here's the real rub: If your insurance policy says you have to elect Medicare Part B if you become eligible, they will process claims as if you had made this election even if you didn't, which means they will only cover, at best, 20% of your cost.  Don't get caught like the patients I've worked with whose insurers went back two years to the date they were laid off and rescinded all of their payments above 20% because the insured could have elected Medicare and didn't, leaving the patient on the hook for the entire cost of his/her health care -- into the hundreds of thousands of dollars.  Think carefully before you turn down Medicare Part B.

 

As health insurance companies tighten their belts, watch out for "step therapy."  We have seen this trend growing.  A Crohn's patient being required to try prednisone before the insurer will pay for any more expensive medications.  A multiple sclerosis patient whose insurer gave her a list of meds to try before they would cover IVIg.  If you can show that there's a reason why you shouldn't have to try the less expensive alternatives -- if you've tried them before, or if there are medical reasons why you can't try them, such as this MS patient, who couldn't try anything with potential side-effects to her liver because she has lesions on her liver -- you can fight with your insurance company and get them to continue to cover the prescription drug you've been taking.  But you need medical records to show either that you've already tried what your insurer requires or that the other treatments are contra-indicated.

 

These and other practices will become more prevalent as insurers try to reduce their costs.  Read your policy.  Pay attention to mail you get from your insurance company.  When you get bad or confusing news, call them and get an explanation of your recourse. 

 

And, of course, call Advocacy for Patients if you need help.

 

As long as we're around, that is.  The economy is hurting nonprofits terribly, as charitable donations take a nose-dive.  If we've helped you and you want to make sure we're around the next time you need us, please use the "make a donation" button to the left and give.  Even the smallest donations will help.  If everybody who gets this newsletter gave $10, it would get us through a month!

 

Thanks.