Private Insurance and IBD
Purchasing your own insurance
In some cases, individuals must either pay out-of-pocket for medication, or purchase their own private insurance coverage. For individuals with chronic conditions, such as Crohn’s disease or ulcerative colitis, this can be difficult.
You have to be strategic when trying to obtain Life, Disability or Critical Illness Insurance coverage while living with an inflammatory bowel disease as going about it the wrong way may cost you more in premiums or leave you uninsured for a period of time.
Tips to help you apply for health, life, or disability insurance:
- Re-apply for insurance when you’re in remission. Your insurability improves after periods of good health.
- Have regular medical check-ups. People under regular medical supervision are rated more favourably.
- Try to find or keep a job that offers group insurance. An applicant's ability to maintain the same job is also an important factor in obtaining individual insurance.
- Do not apply if you have any pending new treatments or medical tests. This is an eligibility question on many guaranteed issue insurance applications. If the tests are part of your regular follow-up (barium tests, colonoscopies, etc.), do not schedule one until you have your coverage. Your doctor will understand and delay booking the appointment if you explain you are in the process of obtaining insurance coverage.
- “Shop around" and try to identify insurance companies which have an understanding of inflammatory bowel disease (IBD). Some companies, particularly those familiar with IBD may offer lower premiums.
- Ask your doctor to write a letter to the insurance company about your condition and request him or her to interact directly with the company's medical director. You are more likely to be accepted for insurance if your physician helps the medical director evaluate the risk.
Read our Talk About Guts article, “You are Insurable!” for an insider's perspective on the insurance industry and getting your own coverage.
- Stay healthy. Following your treatment is important. Whatever condition you have, if it is under control through medication, diet, lifestyle or surgery, you are likely insurable.
ADVOCATE FOR YOURSELF
Issues can still arise even if you have insurance either privately or through your employer.
Here are helpful tips for dealing with common insurance issues:
a. About group benefits
- Be sure to understand the details of your employer’s group benefits package.
- Talk to your human resources department to learn what to expect when making a claim.
- When leaving your employer, your benefits will also terminate. If you are not going to a new employer which offers benefits, you will need to consider obtaining private individual insurance.
b. If your insurance claim is rejected
- Once you have insurance, there may be times when your claim is rejected. First of all, be sure of your rights under your policy. Check to make sure you have not made a claim for something for which you are not entitled.
- If you think you are entitled, don’t let the first or even the second rejection stop you. Persistence is key.
- Use your policy’s appeals process and be sure your physician is supplying the necessary supporting documentation. This may be a case of insufficient or inadvertent information causing the rejection.
- Contact the insurance company’s ombudsman or complaints officer. He or she is there to assist consumers with complaints.
- If you are still not satisfied, request a letter from your insurance company which states their final position and any supporting documentation. You can use the free, national services of the impartial OmbudService for Life and Health Insurance (OLHI) to help you with your claim.
- Be sure to keep a record of all your correspondence and medical information in order for the ombudsman to be able to conduct a thorough review of your case.
c. I’m insured but my drug is not covered
- Recruit the assistance of your human resources department if you are a member of your employer’s group benefits plan. The human resources department should be able to help you with your claim and in some circumstances, the employer has enough persuasive power to help overturn the rejection or get certain drugs added to an approved formulary list.
- If your employer has excluded certain drugs from the approved list of medications for reimbursement, you may wish to disclose your condition to your HR manager.
- Describe your condition and ask your employer either to update the drug plan to include your medication as part of the plan or to make an exception.
- If the drug is not covered, ask your health benefits manager (often the HR manager) why they decided to not to cover the drug. You might be able to apply to alternative coverage. Also, ask if there is an opportunity to apply for interim coverage.
d. Supplemental private insurance
- It is in the best fiscal interests of an organization to keep staff healthy and on the job. It is important you document all of your communication and exchanges with your plan sponsor and/or insurer.
- Some individuals may wish to purchase private coverage or supplement existing coverage.
- You may want to consider working with an insurance agent, especially one which is familiar with and specializes in coverage related to chronic diseases.
- Insurance premiums remain the same whether you purchase your policy by yourself or through an agent.
Managing healthcare for yourself or a loved one can be a daunting task. Persistence, communication, documentation, and information are key to advocating for appropriate care.
- It is important insurance applications are completed accurately. A licensed agent can make sure medical questions are answered completely and in detail.
Click on the links below to download informative pdfs to help you navigate insurance and drug coverage: