Insurance & Disability Claims – Life and Breath Foundation

Insurance & Disability Claims

Life and Breath Foundation / Living Well With Sarcoidosis / Insurance & Disability Claims

Managing a chronic disease also involves managing medical insurance issues and sometimes even disability claims.

Insurance Claims

     Familiarize yourself with your policy, including its deductibles and range of coverage. Then meticulously track all your medical services and expenses to ensure that the services charged are accurate and the insurance company is covering its full share of the expenses, and question anything that doesn’t look correct. Coding mistakes, billing mistakes and incorrect denials of coverage are, unfortunately, common and should be challenged.

     Because some medications for sarcoidosis constitute off-label uses, insurance companies sometimes initially deny coverage for those prescriptions. Learn your insurance company’s appeals process and use it. Many such prescriptions ultimately receive a waiver from the insurance company and qualify for coverage.

     While developing relationships with your doctors, find out if they will advocate for you in the event of a dispute with an insurance company. Often, strong and detailed letters from physicians are needed to convince an insurance company to cover a medication, test or therapy that they initially declined.

Disability Claims

     Filing for short- or long-term disability can be a complex and frustrating activity. Some adjudicators of disability claims have incomplete understanding of sarcoidosis. Consequently, many first-time claims are rejected and must be appealed. Here are a few practices that might help:

  • Get a copy of your employer’s disability program and learn what is required for short- and long-term claims.
  • Don’t be confined by the forms. It is often impossible to completely explain your unique version of sarcoidosis and how it impacts your ability to work. Create an appendix that fully explains your situation and can be readily understood by someone who is unfamiliar with the disease.
  • Get your doctors involved. Ask the relevant doctors to write letters explaining your medical condition and how it impacts your ability to work. Get copies of all notes, test results and scans that your physicians plan to submit with the disability claim and ensure there are no gaps in the data presented.
  • Be prepared to fight. Many disability claims are rejected initially. Be prepared to appeal and, if possible, ask the program to have a sarcoidosis specialist review your claim.