1/16/2018 by Share Your Story

Patient Advocate: What You Can Do if You’ve Been Denied by Your Insurance Company

Patient advocate Diane Talbert identifies steps that every patient can take if they have been denied by an insurance company.


I am probably one of the people that the insurance companies hate. I have been on medications since the age of 5, and my treatments have never been cheap. I have been employed full-time since 1974 and have always had insurance. I have been fighting with insurance companies for years, and it doesn’t seem like things are going to slow down anytime soon.

I take six medications that would cost over $5,000 per month without insurance. Without these drugs, I would be stuck in bed with pain. With them, I am able to work and be a productive member of society.

I refuse to give any power to my insurance company nor do I trust them to do what is best for me. I have always known that the insurance company is a corporation and that they need to take in more money than they pay out. I understand this, but I pay for a service and want to be able to use it.

Having the diseases I have has never been easy. Each and every day I have to maintain my day-to-day symptoms, which has taken a toll on me. In the past 30 years, I have developed psoriatic arthritis, diabetes, high blood pressure and high cholesterol. I just learned in the past 10 years that these conditions are all associated with me having psoriasis, which I have had for 55 years. These are called comorbidities.

I used medication to control my blood pressure so I won’t have a stroke. I have to see my doctor twice a year for this treatment. Research has also shown that people with severe psoriasis are more likely to have a major heart attack.

I see a rheumatologist and a pain management for my psoriatic arthritis. I get swelling in my joints along with stiffness. I have started developing spine and feet pain, which is making it a challenge to go up and down stairs each day.

I was just diagnosed with fibromyalgia and my medication was denied by my insurance company. They are requiring prior authorization and my doctor has to put in writing that I can’t take anything else. I was told that the medication is very expensive and that there is no generic version of this. Here we go again, but I will continue to fight to the end.

Now, do you understand why my insurance company hates me?

Why do they keep taunting me? They constantly have me jumping through hoops. I just want to feel better. I am tired and getting frustrated that this keeps happening to me.

I wrote a letter to my insurance company. I asked them why they are putting so much effort into trying to prove I’m not sick. It’s been 55 years and you still won’t give up. I know you want to believe I’m fine; but I have doctors who keep telling you that I’m sick. Please believe them!

I want the insurance company to listen to my doctors. Stop trying to give me your secret drugs to take. You are not the doctor; how do you know how my body is going to react to it? You keep treating me like a guinea pig. It seems this would be costing you more money in the end. Think about it!!

Steps to Take if You’ve Been Denied by Your Insurance Company

If you should happen to be denied by your insurance company, here are some steps to follow:

  • Find out why you were denied. Call your doctor and the insurance company.
  • Educate yourself about your insurance plan. Do you need pre-authorization?
  • Learn about your disease and what treatments you will need. Did your medical issues began before you joined this plan?
  • Write an appeal letter; find out where to send it. It’s important to do this immediately. You have a time frame to appeal.
  • Keep a log of every call, letter or email that was sent. This process will make you dizzy; so keep account of everything. Take detailed notes; date, time and who you spoke too.
  • Speak to your doctor or your job about advocating on your behalf if you’re not able to or feel overwhelmed. Be nice and polite.

Unfortunately, I take and need a lot of medications. I pay my premiums and feel that if a doctor says I need a medication; the insurance company should not question it or denied me.

I know that to live a long healthy life that I need to exercise, eat right and have a stress free life. I feel that any of us with a chronic disease will always have a fight on our hand. Insurance Company – Why do you continue to take away my medications that help me live some quality of life? There are three words that can sum up what you know about my disease – Nothing at all!!


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