Getting the right diagnosis is only half the battle. Getting your treatment covered is the other half. These episodes break down the health insurance system for patients, caregivers, and clinicians so you can advocate more effectively.
3 episodes · Patients, families & clinicians
Navigating health insurance
Whether you're navigating open enrollment for the first time, fighting a prior authorization denial for a biologic, or a clinician trying to get your patients' medications approved, health insurance is one of the biggest barriers to care for people with chronic allergic and immunologic conditions.
These three episodes were produced in partnership with the Allergy & Asthma Network and the National Association of Medication Access and Patient Advocacy (NAMAPA), with expert guests who work inside the system every day.
STEP 1
Start here
Choosing the right health insurance plan
Open enrollment only comes once a year, and the plan you pick determines what you pay, which doctors you can see, and whether your medications are covered. This episode walks through everything you need to know before you choose.
Ep. 92
Navigating Open Enrollment: Choosing the Right Health Insurance Plan
Lacey Varnon from NAMAPA breaks down premiums, deductibles, networks, and plan types (HMO, PPO, EPO, POS, and HDHP) so you can choose a plan that actually covers your care and your medications
What you'll learn
How to review your doctors, diagnoses, and medications before picking a plan
The difference between HMO, PPO, EPO, POS, and high-deductible plans
How premiums, deductibles, copayments, and out-of-pocket maximums work together
How to evaluate pharmacy benefits and long-term medication coverage
How to use HSA and FSA accounts strategically
Additional resources
Health Insurance Coverage, Allergy & Asthma Network
Choosing the Right Health Insurance Plan, Allergy & Asthma Network
STEP 2
When your medication is denied
Appealing a medication denial
Prior authorization denials are common for biologics, specialty medications, and newer treatments. This episode is the practical guide to fighting back, what to do, who to involve, and how to build a successful appeal.
Ep. 88
How to Get Your Meds Approved: Appealing Insurance Denial
Lacey Varnon from NAMAPA explains why medications get denied, how prior authorization works, how patients and doctors can work together to strengthen an appeal, and what bridge programs and sample programs can do while you wait.
What you'll learn
The most common reasons medications are denied
What prior authorization is and how the process works
How to work with your doctor to document your case effectively
Step-by-step guide to filing an appeal
How to access sample programs and bridge programs while waiting for approval
Additional resources
Why Was My Prescription Denied?, Allergy & Asthma Network
Navigating Insurance Denials & Filing Appeals, Allergy & Asthma Network
STEP 3
For clinicians
Health insurance from the provider's side
Most doctors receive little to no training on insurance navigation during medical school or residency. This episode is for clinicians and patients who want to understand what their doctors are dealing with behind the scenes.
Ep. 89
Health Insurance 101 for Doctors: Navigating Claims and Coverage
Elizabeth Johnson walks through the biggest challenges clinicians face in securing medication approvals, introduces the NAMAPA toolkit for healthcare providers, and makes the case for why insurance education needs to start in medical training.
What you'll learn
Common hurdles doctors face in securing medication approvals
How prior authorization processes differ across medications
The NAMAPA toolkit for healthcare providers and care coordinators
Resources from pharmaceutical manufacturers to support the approval process
Why insurance education should be part of medical training
Additional resources