Since all of the provisions of the Affordable Care Act (ACA) became final in 2014, more than four million previously uninsured people have gained access to affordable or free healthcare (with an eventual target of just over 11 million). This number includes many with chronic pain who were unable to get health insurance due to a pre-existing condition. It also brings the rate of uninsured people in the U.S. to its lowest level in 50 years.
While this new health coverage is definitely a welcome change, many people with chronic pain are now faced with the challenges of navigating an often-confusing system of new lingo, endless forms, and pre-certifications. Here are nine ways to make navigating health insurance challenges with chronic pain a little easier.
1. Know that the Affordable Care Act has your (increasingly pain-free) back
In 2010, the bill that would become the Affordable Care Act required the Department of Health and Human Services to work with the Institute of Medicine to examine chronic pain as a public health issue. These two organizations found that chronic pain is a serious issue that can be considered a disease in its own right and should be treated accordingly. Their report called for comprehensive, coordinated treatment plans that include all aspects of chronic pain, including mental, physical, and emotional challenges.
This is good news because even with its sometimes confusing aspects, from the beginning, the goal of the ACA is to help simplify and coordinate care for chronic pain. If you can approach navigating this new health insurance with that thought in mind, you are starting in a good place.
2. If you have health insurance through work, talk with your human resources department first
Although many human resource managers are struggling to keep up with changes in health insurance requirements and reporting, they may be able to offer some insight into how best to approach the new system implemented by the ACA. If you have not had health insurance before, your human resources department can explain the different plan levels (platinum, gold, silver, and bronze) and help you choose a plan that fits your budget and your needs.
They can also help you apply for subsidies to see if you qualify for a reduction in your monthly premium. You may be reluctant to discuss your financial situation at work, but this type of conversation is protected by ethical confidentiality rules. Feel free to even ask your human resources manager to keep it confidential if that makes the conversation easier.
3. If you are purchasing health insurance for the first time and are on your own, look online
The Affordable Care Act’s official website had some trouble when the law was first enacted, but for the most part these kinks have been ironed out. The site has screened all qualifying plans for each state and offers tools to not only compare plans but to also apply directly online for benefits and subsidies. The site is bilingual in English and Spanish and features many articles and FAQs on the different types of coverages available. You can also contact the governing agency directly by phone, email, or mail for answers to all of your questions.
4. Find your “medical home”
The Affordable Care Act stresses the importance of a patient-centered “medical home.” This is also known as a primary care physician, but under the ACA, the medical home is even more comprehensive. Many plans send all specialist referrals through the medical home, even if that is not how it worked in previous plans. Your medical home is also charged with coordinating care and communicating directly with you, reminding you of appointments and refills at the pharmacy.
While getting a specialist referral through your medical home may be difficult to get used to, think of it this way: no more searching on your own. No more tracking down charts and test results and scheduling visits. Your medical home can schedule everything for you and send you home with a print-out of your appointments.
The American Cancer Society is already ahead of the curve in comprehensive care coordination with their Patient Resource Navigators. Each patient is assigned a navigator in over 100 hospital systems across the U.S. This navigator helps patients coordinate care, find transportation, and generally work to support each patient with the complexities of finding and receiving treatment. This ground-breaking program would be a great way for chronic pain patients to navigate not only health insurance issues but also treatments in general.
5. A medical home means choosing a doctor wisely
People without chronic pain may see their doctor once a year for an annual check-up (free under the Affordable Care Act). This casual relationship makes choosing a doctor less important; if you don’t like them, you only need to deal with them once a year for an hour.
For patients with chronic pain, choosing a doctor that works for you is of the utmost importance. You may see this doctor once a week. This is the same doctor who should be striving actively to find a solution to your chronic pain. Health insurance with the wrong doctor is nearly as bad as no health insurance. Ask friends and family for recommendations, and don’t be shy about asking the doctor’s office for a quick visit to meet the doctor.
6. Learn the lingo
Especially for first-time buyers, the terms of health insurance can be confusing, causing many to just close their eyes to randomly pick a plan. Even many experienced users of health insurance have no idea what “coinsurance” is or what qualifies as meeting the deductible.
Many of these terms are defined deep within each plan’s documents, but simple definitions are also available online. Using Healthcare.gov’s online comparison tool combined with clear definitions can help to see the differences between plans more clearly.
Even with this confusion, the rate of uninsured 19-34 year olds decreased by 10% from 28% to 18% just during the first enrollment period. Many of these patients are chronic pain patients who are receiving coordinated, comprehensive care for the first time.
7. Once you choose a plan and a doctor, gather all of your records
Most doctors have a form to fill out that will expedite the process of transferring records, but for your initial consult, bring any notes, prescriptions, X-rays, or other test results. This can help your new doctor get up to speed as quickly as possible so that there is no lapse in treatment.
8. Ask about online access to your records
Many physicians are working towards online access to all parts of a patient’s record, from online prescription refills to instant test results delivery. Ask your doctor how to sign up for these services, and check them to make sure all visits to specialists and complementary care providers are included. For chronic pain patients with a complex medical history, this online access can streamline the process of explaining previous treatments and tracking the efficacy of new ones for both doctor and patient.
9. Finally, know your rights
You have the right to access a physician who is compassionate and dedicated to helping you find a treatment that works for you. Chronic pain treatment is a marathon, not a sprint, and your doctor should be committed to you every step of the way. If you feel like your concerns are not being heard or addressed, you can change your doctor at any time. Because so many records are online, the process is easier than ever before. You can even change your insurance plan every year during open enrollment. If your doctor is not meeting your needs, it is well within your rights to look for another one.
Have you had challenges navigating health insurance with chronic pain? How have you overcome them?