Financial Issues

Chronic pain can affect all areas of your life including your finances. The following are some practical financial tips to cope with the financial issues that often go hand-in-hand with a chronic illness.

If you are using an HMO or PPO insurance type of plan to pay for your pain treatment, the following information may be helpful to you:

1. Find out what pain management services are provided under your current insurance plan. Note: many HMO/PPO plans may not address pain issues directly and some do not provide coverage.
   
   
2. Find out what medications are covered by your insurance. Many insurance plans have a list of medications that they will pay for (this is called a formulary). Often times the insurance plan does not have several of the medications used to treat pain on their formulary. In that case, your physician will need to write a special appeal letter to see if the medication can be covered.
   
   Many types of pain are treated with medications used to treat other conditions,  (called adjuvant medication). Sometimes insurance companies won't pay for a medication that is used for a different use (for example, Tegretol is used mainly to treat seizures but can also be helpful for certain pain conditions). In that case, your physician will need to write a special appeal letter to see if the medication can be covered.
   
   
3. If your primary care doctor refers you to a specialist or for treatment somewhere outside his/her office, always check with both your insurance company and the specialist that you are being referred to to ensure that they are a part of your insurance plan. Note: if the physician/nurse is not a part of your plan it will usually cost you more out of pocket.
   
   
4. Many HMO/PPO plans require you to have a referral from your primary care doctor in order to see a specialist. ALWAYS get a copy of the referral or the referral number and keep it in your records. This is your proof to the insurance company that you had the referral.
   
   
5. Many HMO/PPO plans also require you to have pre-authorization for the service. This is something that is in addition to the primary care referral. The insurance company issues pre-authorization. You may want to check with the insurance company prior to seeing the specialist to make sure that your visit(s) are pre-authorized.
   
   
6. The day before you see a specialist you may want to call his/her office and make sure that they have received both the referral from the primary care physician and pre-authorization for the visit. This will protect you from going to a visit where you will have to pay for services that your insurance won't cover.
   
   
7. Most insurance companies have a customer service department. Call them should you have any questions regarding what is a covered benefit or why a service is not being covered. If you don't receive answers to your questions by talking with the person who answers the phone, ask to speak to a supervisor. You are a consumer of your health care and you deserve excellent service.
   
   
8. If you believe that you have received an incorrect bill, always notify the insurance company as well as the doctor, hospital or clinic that sent you the bill. Don't be afraid to ask questions until you receive the answers that you need.
   
   
9. If you have problems that are not resolved to your satisfaction, you can call the customer service department at the insurance company and ask for a supervisor. If that does not provide the results you are looking for you can call your state insurance commissioner.
   

If your pain is the result of a work injury or a personal injury such as a car accident, the following information may be helpful to you:

1. File an injury report form with your employer or your car insurance carrier as soon as possible.
   
   
2. Find out your case number. Write this number on a piece of paper with the date, time, and location of your injury (most everyone you visit will ask for this information).
   
   
3. Find out if you have a case manager assigned to your case. If you do, write down his/her name and phone number on the same paper as the other information listed in tip #2.
   
   
4. Find out what your rights and responsibilities are under the laws in your state. You may be entitled to compensation for the time you are off work, the time it takes you to see your health care professionals as well as other expenses.
   
   
5. If you have a case manager it is helpful to inform him/her of appointments with your health care professionals or even have them coordinate the appointments for you. In addition, it is helpful if they know what treatments and medications have been recommended so that they can facilitate payment for those items.
   
   
6. If you are having difficulty reaching your case manager or if you are having difficulties with reimbursement or payments it may be necessary to talk to a supervisor at the insurance company. You should have your questions and concerns addressed to your satisfaction. If that does not occur even after talking with a supervisor you may find assistance by contacting your state insurance commissioner.
   
   
7. If you continue to experience difficulties or if you have questions regarding your rights and responsibilities under the law it may be helpful to contact a personal injury attorney.
   

General information:

If you feel as if you are in over your head and overwhelmed with your financial obligations your stress level will go up and it is common for anxiety and depression to follow. Get some assistance with financial planning. There are several free consumer credit counseling agencies/groups.

 

Last Updated: 08/11/09