Don't Take NO for an Answer: How to Overcome Your Insurance Company Choosing Your Pharmacy for You
Michelle J. Sherman, R.Ph., A.A.H.I.V.P.
By now you have probably read my original articles "Know Your Pharmacist, Know Your Pharmacy" and learned how your pharmacist is a key member of your health care team, and "10 Steps To Choosing The Pharmacy That's Right For You." Now that you're armed with this information, what do you do when you can't shop around for an HIV pharmacy in your area or you have to just use the closest one that takes your insurance?
This can sometimes be a challenging task because you may be feeling sick and tired and now you have to "fight" with your insurance company once again, and we all know the experience can be stressful and unpleasant. Being your own advocate and rallying those around you to advocate on your behalf to ensure you get the best HIV care possible is essential to your quality of life.
Here are some recent quotes I have from clients and nurses relating to the importance of your community HIV pharmacist.
As members of the care team, Community Pharmacy and Pharmacist are vital to patients' safety and well being. Their knowledge, skill and compassion are critical to positive outcomes.
As a nurse who has cared for HIV patients for the past 20+ years, I know the clients depend on the expertise of certain local pharmacies that give specific information and instructions, check other med interactions, label in several different languages, and are a resource for dealing with side effects and other AIDS-related medicine questions and problems. It would be a disservice to my patients and me as a caregiver for them not to.
I believe that providing the best possible care to HIV patients that meets their complete needs should be a priority.
Here are some tips to help you shop around for the right HIV pharmacy for you, one that takes care of your needs, makes you feel comfortable and can become a key member of your health care team:
- Don't take NO for an answer: The first reaction for an insurance company is to say "no." Most people will not challenge the response, accept it and have to live with the consequences. Don't accept the "no"; fight it, and challenge it. Ask to speak to a supervisor and tell them that you want to use the pharmacy of your choice, not their choice, that will provide you with the best care possible. You know what they say: "The squeaky wheel gets the grease."
- Explain to insurance company why you need to use a particular pharmacy that you've selected or continue to use the one you trust.
- You are the "captain" of your team. Remember that you are in charge of your own destiny. Your physicians, nurses, case managers, pharmacist and other health care providers are your team. Be a strong captain and go for the win ... tell your team what you expect from them and guide them to the win. You guide them to win by providing them with all the information about you and your health so they can devise the best health care plan for you to succeed.
- Rally your team to advocate on your behalf. When you get tired of fighting and need some help, get your team to advocate on your behalf. You will be surprised what can be achieved when you're not battling by yourself.
- If the insurance company mandates you must use a particular pharmacy that does not suit your needs, ask for an exception. Invariably the insurance company may deny your request to switch to the pharmacy of your choice. Don't give up, pursue it and ask for an exception to be able to go where you feel comfortable.
- Can't find a local HIV specialty pharmacy? Look online (Google or Bing). If you are unaware of a local HIV specialty pharmacy in your area, look online and you may be able to find one there that suits your needs.
- Read online reviews such as on Yelp: Reading online reviews helps to get an idea of the type of pharmacy, their service and who they are.
- Get a referral from friends, support groups, case managers, doctors, nurses: There is nothing like a recommendation from your friends or your health care team for good pharmacy services.
- Contact your local legislatures, senators and congressmen to allow freedom of choice in your health care. Be that squeaky wheel and make our politicians come to task to protect your rights.
- You must feel comfortable with whichever pharmacy you choose!
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