Anna Wilde Mathews

speaker

275 appearances 5 recordings 1 series first heard Aug 2017 last heard Sep 2023

Anna Wilde Mathews’s voice in public audio — every appearance, attributed to the second.

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WSJ Your Money Briefing · How to Appeal When Your Health Insurer Rejects a Claim · 28 Jun 2023 podcast

So you see a lot of folks out there these days seeking coverage for the drugs that are similar to Ozempic, Wagovi in particular.

But you'll find that some plans, and Medicare actually is included here, just don't cover drugs if you're trying to take it for weight loss.

So if you're appealing that, that really can be sort of an upwards battle and a harder thing to win.

Well, it's definitely helpful to seek out some kind of help or an advocate.

The first step there is often to go to your doctor's office or the hospital or whomever was working with you to provide that care because they may know the most.

But there are also a lot of private and government entities that might help.

A lot of states have these operations called consumer assistance programs.

A few examples, for instance, Connecticut has one.

New York has one.

And they can help people with appeals and they do a lot of appeals in their state.

So if you're in Medicare, there are these programs called state health insurance assistance programs that specifically deal with Medicare.

There are also nonprofits like the Patient Advocate Foundation that will work with folks who need help on appeals.

One good first step can be to call your state insurance regulator.

Every state does have one.

They don't always deal with appeals themselves, but they should typically know the process and might be able to help you understand it better.

honestly, even before you come to the point of needing to appeal something, it's really good to have information and good background about your policy.

So even before you seek the care, it might be good to figure out, is this something that's going to be covered before you're fighting them on the back end about something you thought was covered?

So what consumer advocates told me is that you probably should have the plan documents for your health insurance just around, right?

Keep it digitally someplace.

There's a document called the Summary of Benefits and Coverage.

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