A Paper-Chase for Patients

A glossy insert slides out of the Weekend USA Today as I opened it to skim the news and lifestyle sections on my Amtrak home from vacation. The title font proclaims “Lung Health.” OK, now I HAVE to peek and see what the latest headlines are.

After articles on lung cancer and lung fibrosis, I see “The Dangerous Health Insurance Policy that is Harming Asthma Sufferers”. Step therapy is the policy that the author of this article is questioning. If you are subject to Step Therapy your insurance requires you to fail various treatments before allowing you to proceed with a higher step of treatment.¹

Insurance changes are frustrating

The subject of the article in question had a complicated experience with step therapy because her health insurance plan changed midway through a series of procedures to relieve symptoms from her severe asthma.¹

I can sympathize with her plight of switching insurance and having a new set of paperwork to get medications, doctors, and other necessities approved. When I transitioned to my current insurance from a previous one, I spent several lunch breaks chatting with insurance representatives and doctors' offices getting everything in order. Persistence is key to getting these kinds of things sorted out.

Step therapy for asthma management

As I understand it, health insurance tells me “no” or makes me jump through hoops like step therapy in an attempt to control costs. I do my best to remember I want affordable insurance and medical costs, which comes at the expense of some paperwork hassles. I am sympathetic with the woman who was unable to get the treatment her doctors recommended. There is no easy answer to this problem.

Pending new regulations on healthcare policy, my answer to the challenges of step therapy and other cost control measures is to actively participate in my care. I take it as homework before any appointment to check what updates to my insurance might impact my care. I know what lab I should have blood work orders sent to and bring the cheat sheet pharmacy formulary summary with me. Ultimately be on the hook for charges if insurance does not pay. I want my insurance to pay their fair share so I do my best to play by the rules.

I normally would take issue with being categorized as an “asthma sufferer.” However, I would say I don’t suffer from asthma because I have access to treatments that control my symptoms. I expect that were I unable to access these treatments and unable to appeal my denial of treatment, I would be suffering.

Patient empowerment is key

In my view, suffering ends when empowerment begins. Step therapy, in my opinion, is the symptom of the larger problem of patient and physician disempowerment. It is the insurance company telling my healthcare team and me that they know better than us how best to treat my asthma.

To the people writing these policies, I am not Kat, the knitter and cyclist, I am subscriber #____ of thousands with asthma. Subscriber #____ is the success story of reduced medications (therefore costs) with thus far no adverse side effects. I am not just the protagonist but a co-author in this odyssey. Are you working to rewrite your asthma and insurance destiny?