b'example,ifaplandoesnothave vision Ask for explanations. According to the coverage, the insurer may question the needAmerican Medical Association, an average for ophthalmology services related to visualof 9.5 percent of medical claims processed symptoms of MS. Many times, this failure tobyprivateinsurerscontainerrors.So understand the medical necessity can lead towhen coverage is denied, dont accept a failure to receive preauthorization or athe simple answer. If you are told a claim declined claim. Often, your doctor explainingis deemed not medically necessary, not the medical necessity of a service is all that iscovered under your plan, etc., probe a little required to resolve the issue.deeper. Ask why. Dont hesitate to politely Of course, there are other reasons yourask to speak to a supervisor or someone insurance company may decline to cover awho can explain the companys position service, but whatever the reason, dont feelto you. you have to take no for an answer. The law Be detailed. Keep track of who youve gives you the right to appeal, both internallyspoken to at your insurance company and (areviewofyourclaimbytheinsurancewhat was said. If cognitive issues prevent companyitself)andexternally(wheretheyou from doing so, use a speakerphone claim is reviewed by an independent thirdand ask a family member or friend to party). According to Kaiser Health News, aroundtake notes. You will need this information 50 percent of all appeals are successful.to understand the companys case and Here are some tips to help you avoid andform the basis for your appeal. address problems with access to care throughHurdle 3: I dont know when to ask for a referral. health insurance:Office visits can go by very quickly, andKnow what your plan covers. Most insurersyour doctor may only ask about some issues make this information available on thethat are on your mind. It is important to speak planswebsite.Ifyouhavequestionsup about any change in symptoms, even if about a service that is not listed, call thethose symptoms are currently manageable. insurer to be certain.Early intervention by a specialist can oftenAsk whether preapproval orprevent symptoms from worsening. preauthorization is necessary for servicesSome specialists can best serve you ifyou havent used before. Make certainyouve had an evaluation soon after your authorization has been provided beforediagnosis. This evaluation establishes a you go for the service.baseline and helps monitor any changes overKnow how many visits are allowed. Certaintime. Other specialists are only needed when services may have a cap on the numberneworchangingsymptomsaffectyour ofvisits,particularlytherapyserviceshealth or ability to function independently. (physical, occupational, speech, or mentalIt may be difficult to gain insurance health). Work with your therapist topreauthorizationforbaselineevaluations. maximize yourtreatmentduringthatSome providers choose to wait for the rst number of visits. If the therapist feels it isreport of symptoms to refer you to a specialist. medically necessary for your treatmentThis approach requires you to be active in to continue after the cap is reached, younoting and communicating changes in can appeal the cap.functioning to your healthcare provider.7 msfocusmagazine.org'