21 msfocusmagazine.org are more expensive than in-network claims. (A tip if you find yourself in this situation when choosing insurance plans: If your MS specialist is not in-network and you are going to switch to an in-network option, make sure that you go to your current provider and sign a release of medical records. You will want to make sure that your new specialist has access to your entire medical history.) Youwillalsowanttoensurethatyourcurrent MS treatment is on the formulary. Whether your treatment is on the formulary or not, you may have to prove medical necessity to continuetreatment.Whenswitchinginsurance, it is ideal to maintain continuity of care. As a person living with MS, you can be proactive about managing this transition. If you have selected an HMO plan, it is important to get established with a primary care physician. You will want to make an appointment with the PCP as soon as the plan is effective in order to get a referral to see the MS specialist. Once you have that referral, contact your MS specialist to get scheduled for an appointment. If you opted for the PPO, you can skip this step. The MS specialist may have to submit for prior authorization before the appointment. During that appointment with your MS specialist, your neurologist will write a prescription for your MS treatment. If you get these appointments scheduled, you should have no delay in treatment. It is also recommended to get a letter of credible coverage from your previous insurer, so that your new insurance knows your MS has been managed continuously by another insurer. This may also help with the referral and authorization process. Health insurers cannot deny coverage because of a pre-existing condition,butitisagoodideatocollectasmuch information as possible from your previous insurer to ensure the continuity of care. Let’s say that you follow all these steps and you get a letter in the mail stating that your MS treatment got denied because of medical necessity. If you get a denial, it is important to know that it is not the end and that you have the right to appeal the decision. Your MS specialist who wrote the prescription will also get a copy of the denial. If you get a denial, first call your MS specialist. There is a chance that they simply need to provide additional documentation to supportthemedicalnecessityofyourtreatment. Also, call the insurance company and let them know your intention to appeal the decision. The insurance company will have patient advocates and case managers that will help you with the appeal. Your MS specialist may also call for a peer-to-peer review with the insurance company to get your treatment approved. If all options have failed and you have exhausted all appeals, you have the right to file a grievance with the insurance company. Tofileagrievance,youshouldfollowtheprocess outlined in the policy, or contact the health and human services branch of your local government. (For more detailed information on denials, see the article on page 22.) While the details of your situation may be different, hopefully this hypothetical scenario has helpedyou to understand a bit more about your insurance options. Switching insurances shouldn’t mean that you have to delay your treatment or care, but it is up to you to be proactive and make sure that the transition to a new insurer is seamless.