Even with the best preparation and a great care team, you may have difficulty getting access to the right treatment for you. There are many factors involved in determining how easy or hard it is to get access to the right treatment. These can include whether you have insurance, and if so, what type (Medicare, Medicaid or private insurance); who your healthcare provider is, where you live, and which medical condition(s) you have.
Depending on the answers to these questions, there may be resources to help you gain access to the treatment you need. These can include pharmaceutical companies, nonprofit groups and state programs.
Many states have medication assistance programs. Often these programs are designed for the elderly, disabled or people in financial need. Some programs are for people with specific medical conditions such as end- stage kidney disease or HIV/AIDS.
For Medicaid patients, the state ombudsman programs can be a resource for claims denials. Find information about your state’s Medicaid program here.
For Medicare patients, you can find information on appeals if you have Medicare prescription drug coverage here, and information on appeals if you have a Medicare health plan here.
Beneficiaries are directed to their State Health Insurance Assistance Program (SHIP). You can find the phone number for your state’s SHIP by visiting Medicare.gov/contacts or by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Or visit this link to search for your state SHIP contact information: https://www. shiptacenter.org/allstate/va/
Other helpful resources include:
It is quite common today to seek a second opinion. It is your right as a patient to get a second opinion. You will get more information that will help you decide your choice of treatment.
Most doctors are comfortable with a request to seek a second opinion. Some insurance companies even require one before they will cover certain treatments.
There are many reasons to seek a second opinion. Some patients want to affirm that what their doctor has recommended is the best course of action. Patients with a more rare disease who are not being treated at a major teaching hospital may want to consult a specialist who regularly treats the disease. If you can’t be seen by the specialist on a regular basis, the specialist may be able to consult with your doctor and make a recommendation about treatment. He or she may know about clinical trials and specialized treatment that you can benefit from.
Other reasons you may want to get a second opinion include:
If you’re unsure how to ask your doctor for a second opinion, the American Cancer Society has suggestions for how to jump-start the conversation:
Before you go for a second opinion, call your insurance company to find out what they will cover. Some companies will only pay for a second opinion if you get one from another doctor who is part of your health plan.
Once your appointment is set, gather all of the following information to bring (and keep copies for yourself):
Your doctor’s office will be able to give you a copy of your medical records. The medical records department of the hospital will have records of any treatment you received in the hospital.
If the doctor who provides a second opinion has a different approach than your doctor, it can be difficult to decide how to proceed. The American Cancer Society recommends some steps you can take: