If we don’t advocate for ourselves, how can we expect others to do it?
How can we advocate about something if we don’t know what it is?
Learn how to speak chronic illness so that
you can effectively advocate and educate.
Co-pay Assistance Bans – Insurance companies reject coverage for patients who receive financial aid to pay for their co-pays. Some of that co-pay assistance comes from the pharmaceutical companies, who can keep their prices high yet take a charitable deduction by running their own assistance programs. If these bans take place, patients would lose access to needed medicine while pharmaceutical companies lose their write-offs.
Donut Hole – The donut hole is a Medicare coverage gap for prescriptions. Once you’ve reached your deductible, you pay less out of pocket until you reach the coverage gap. Then you have to pay 100% of drug costs until you hit the catastrophic level, when coverage kicks in again. This gap should go away by 2020 (some say 2019), but changes to legislation could change the gap – for better or for worse.
Drug Price Tiers – Insurance companies categorize drugs into tiers and charge patients higher costs for the higher tiers.
Limited Networks – Insurance companies restrict which providers are covered, which limits options for those with chronic illnesses.
Non-Medical Switching – To protect profits, insurers will force patients off their prescribed, effective medication and onto a cheaper alternative for reasons unrelated to the patients’ health or safety. So if at first you don’t succeed, insurance resists letting you try, try again.
Premium Insurance Bans – Insurance companies can force patients who receive financial aid from charitable organizations and other programs to drop private insurance.
Primary Health Care – Focuses on essential health care that incorporates equity, affordable costs, and community involvement and participation.
Prior Authorization – Prior authorization is a practice used by many insurance companies that occurs before they will agree to cover certain prescribed medications or medical procedures. If they don’t approve it first, insurance companies won’t pay.
Public Health – Focuses on the quality of life and health among whole populations.
Risk Adjustment – Risk adjustment provides incentive for insurance companies to cover higher risk patients. The insurance companies get financial compensation for enrolling higher risk individuals. That makes it easier for people with chronic illness to find affordable insurance options.
Step Therapy – Step therapy is a practice many insurers employ that requires the patient to try cheaper, alternative drugs that are not recommended or originally prescribed by the doctor. Also known as “fail first”, since you won’t be allowed to use the drug you need unless at least one cheaper alternative has failed.
Telehealth- Technology allows care to be delivered remotely and can be used for consultations, remote monitoring, and provider collaboration.
Keep checking back here for more terms to help you speak up.
Last updated: 08/21/2018