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Healthcare Today Medicare and Insurance

Your Health and Your Insurance

Summary & Participants

Health insurance is important to everyone, especially people with chronic conditions like Crohn's disease and ulcerative colitis. Tune in to watch highlights from a panel discussion offering advice on how to handle problems with insurance providers.

Medically Reviewed On: August 21, 2003

Webcast Transcript

BETTINA GREGORY: Hello, I'm Bettina Gregory. Recently I hosted a panel sponsored by the Crohn's and Colitis Foundation of America on insurance issues relating to inflammatory bowel disease. I was joined by Jamie Jameson, a registered nurse with Health Connections. That's a company that helps people with medical reimbursement insurance issues. Also joining me was Joseph Moynihan, a health insurance consultant. I began by asking Joe, what's the best health insurance option for people with IBD?

JOSEPH MOYNIHAN: In the United States, people that have group health insurance through their employer is the best possible option for a variety of reasons, but the two most important is it's broad coverage, and it's cost-effective. There's usually an employer subsidy that allows for it to be; health insurance remains to be a cost-effective benefit.

BETTINA GREGORY: Okay, now we're talking about people who have jobs, but in this day and age people very often change jobs, perhaps more than once, during their career. Does that health insurance benefit travel with them?

JOSEPH MOYNIHAN: Portability is a very important issue, and several years ago, 1996 to be exact, Congress passed the Health Insurance Portability and Accountability Act, otherwise known as HIPAA, and among its provisions, which are extensive, is a what's known as a certificate of continuing coverage. And provided that you meet the eligibility requirements of your previous employer, that certificate can be presented to your new employer, and that new employer can't impose preexisting condition exclusions on you or a family member.

BETTINA GREGORY: Well, we've been talking about the range of insurance coverage, but what about the problems that relate to patients with IBD when they have insurance coverage? Well, that's where we turn to Jaime Jamieson as our expert on that. What are the main problems people with IBD have trying to get medical reimbursement?

JAIME JAMIESON, RN: Well, one of the primary obstacles would be exclusions for or non-coverage for certain drugs. Very often it's the newer, more expensive drugs. These limitations or exclusions or carve-outs, as they're often called, are often put in place because it makes the policy less expensive for the employer or the individual to purchase. Unfortunately, the patient may not be aware of these restrictions until they actually need those services.

There are also restrictions on dosage and frequency of drug use. A particular drug, let's say, the standard usage might be one time every four weeks. Your physician, however, prescribes it to you every two weeks because he feels you'll have a better response. If your insurance company does not approve that ahead of time, you may not have coverage for it.

BETTINA GREGORY: Well, finally I'd like to ask each of you for some tips for those who are trying to get insurance coverage and for those who are trying to get reimbursement.

JAIME JAMIESON, RN: Well, as we said before, be persistent. "No" does not have to mean "no." In my experience, your written insurance policy really is a starting point, a guideline for how benefits should be administered. But it's definitely not the final answer.

JOSEPH MOYNIHAN: My suggestion would be, become a student of the rules and regulations that apply to your health insurance plan, both your current health insurance plan, and have a strategy to deal with the issue of, if you leave employment and go to another job. Or, in the event that you're terminated, what is going to happen? There's laws, both federal and state, again, that help you in that effort. But the overall message is, become a student, become knowledgeable, and you'll be your own best advocate.

BETTINA GREGORY: Those are some of the highlights of our panel discussion on insurance and inflammatory bowel disease. My thanks to Jamie Jameson and Joseph Moynihan. The panel was sponsored by the Crohn's and Colitis Foundation of America. I'm Bettina Gregory.