Getting Past Insurance Problems:

A Guide for Patients with Thyroid Disorders

Making it through each day can sometimes be a challenge for patients with thyroid disorders. Managing symptoms like the anxiety and restlessness of hyperthyroidism or the crushing fatigue and depression of hypothyroidism can be draining in and of itself, and dealing with doctors, physicians, and even friends and loved ones who don't always understand the impact of these diseases can add insult to injury.

On top of all of these issues, a growing number of thyroid patients have begun to encounter difficulties when dealing with HMOs, private health insurance companies, or government health agencies. Common complaints include denials of service, rejection of treatments deemed to be too "experimental," or refusal of coverage for treatment of symptoms and health problems that result from thyroid problems.

If you or a loved one has encountered these kinds of difficulties, don't panic and don't despair. Although it can be a long, challenging process, it is possible to negotiate with your health insurance provider and achieve a successful outcome. This week, we'll take a look at some methods you can use to help persuade your insurance carrier to provide better coverage for your thyroid disorder.

Navigating the Maze of Health Insurance

Over the course of the last several decades, the health insurance industry has gone increasingly complex. With the rise of HMOs and managed care in the 1980s, more insurance companies began to focus on the costs of health care -- and devising ways to minimize their own payouts to patients.

Supporters of the insurance industry argue that a focus on the cost-effectiveness of common treatments benefits everyone by keeping the price of health care down. However, opponents of this approach contend that a growing number of the decisions made by health insurance companies seem to be based on dollars and cents, rather than compassion or genuine concern for the patients' best interests.

This whole debate grows even more complicated in the context of treatment for thyroid disorders. The thyroid gland -- and the endocrine system as a whole -- is enormously complex, and scientists are continuing to work toward unraveling the mysteries of its function and role in the body. Compared to many other organs, the thyroid gland was discovered relatively recently, and it is only in the last several decades that the full spectrum of thyroid disorders have been identified and described in the research literature.

Another problem is the fact that thyroid disorders can cause an extremely broad array of symptoms. A patient with hypothyroidism, for example, may also be grappling with obesity, chronic fatigue, and depression, to name just a few. If not directly caused by the thyroid imbalance, all of these symptoms are surely exacerbated by improper thyroid function. Still, these are exactly the kind of broad, indistinct symptoms that insurance companies often balk at covering.

Generally speaking, most thyroid patients typically experience little or no difficulty receiving full coverage for the symptoms that are directly related to their diagnosis. However, once you move outside of that small circle of clearly-defined symptoms, you are more likely to run into trouble.

Acting As Your Own Advocate

So, what can you do if your insurance company, HMO, or government health care plan has refused to pay for a thyroid-related disorder? Surprisingly enough, there are many avenues for recourse if you have been denied coverage. Here are some tips that can help you work through this challenge.

• Document everything. It's absolutely vital that you record every interaction with your insurance company. Get a notebook or binder and use it to collect documentation. Every time that you speak with a company representative over the phone, make a detailed factual journal entry about it, including the time, date, and name of the person you spoke with, as well as a concise account of what happened in the call.

• Practice detachment. It's easy to get emotional when your health and well-being are on the line, but your campaign is likely to be much more effective if you can stay as calm and poised as possible. Imagine yourself as a lawyer or mediator who wants the best outcome for the case, but who isn't personally impacted by it.

• Don't take 'no' for an answer. If you're turned down, it's not the end of the world. The company's policies are open to interpretation, and if you persevere, you may get a more favorable reading from another company representative.

• Take the escalator. Each time that a customer representative denies coverage, take your case to the next level in the organizational chain. Once you sense you've reached an impasse, calmly request to be transferred to the supervisor or manager. Keep escalating your case until you get the outcome you want, or until you reach the executive level. If you've talked to the CEO and you're still not satisfied with the results you've gotten, it may be time to consult with an attorney.

For Further Reading

• http://www.smartmoney.com/consumer/index.cfm?Story=20020509

• http://www.cnn.com/2007/HEALTH/07/19/patient.insurance/index.html