By Patrice A. Johnson
Do you know what your health care insurance plan covers? Are they transparent in stating on their website what specific issues may be of importance to you and your family? Do you know what their policy is on cost sharing, prior authorization, step therapy, as well as what their appeal process is?
I am an arthritis patient living in Reno. I have had Osteoarthritis in my left for 39 years. I was diagnosed with Osteoarthritis in my hands, hips, spine and lower back five years ago. I also have Rheumatoid Arthritis, which I was diagnosed with 13 years ago.
Many of our citizens in Nevada have some form of arthritis. Arthritis is a debilitating, incurable and chronic disease. Arthritis affects the health of our community regardless of age, gender or any other factors.
The solution is for health insurance plan transparency to include on their website specific information on issues of importance to people with arthritis.
Health plan insurance transparency is critical to arthritis patients or any person living with serious medical issues. Resource materials must be easy to understand and incorporate the patient perspective.
Arthritis medications can be very expensive. Health insurance plans need to disclose all copayment, coinsurance and out of pocket cost obligations for each medication, as some arthritis patients require multiple medications. It should be in the form of a clear and easy to use searchable listing of medications covered by their health plan, with medication name and disease type. There are over 100 forms of arthritis and you can have more than one form.
Many patients do not know they have a right to appeal an insurance denial. In the case of a denial, healthcare plans need to detail why there was a denial, a patient’s right to appeal and how to appeal the denial. That would also include a time period in which an appeal can be made.
In the state of Nevada, 23.7% of our community is affected by arthritis. An estimated 477,000 adults in Nevada are living with arthritis. Over 1000 children in our state have Juvenile Arthritis and 1-in-3 veterans in our state has arthritis. Among adults in Nevada, 47.3% have work limitation due to arthritis. There is a higher prevalence of arthritis in rural communities (30%), compared to Washoe County and Clark County, each with 22%.
Addressing the issue of health plan transparency will require commitment and collaboration. Join me in writing to our legislators or attending a town hall in our community to bring awareness of healthcare plan transparency.
Patrice Johnson represents the Arthritis Foundation as a volunteer. She is the Nevada State Platinum Ambassador (patient advocate) and the Nevada State Advocacy Chair.
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