EXTRA Part 1- What’s the Cheat Code for Insurance Companies?

Insurance companies devise new ways to save and make money. One method is called utilization management, where insurers direct patients to treatments that are counter to what the patient’s doctor recommends. Utilization management is so important and controversial that we’re devoting two episodes to the topic, so patients are better informed and can better advocate for themselves.

“Imagine being in the exam room with me and my neurologist and then getting told by your insurance company that you're not eligible for the treatment that you both decided would work for you. That's what happened to me,” says Joe Coe, Director of Digital Education and Strategy at the Global Healthy Living Foundation and host of the Talking Head Pain Podcast. “And my neurologist needed to do a ton of paperwork called prior authorizations to get my medication approved.”

Among the highlights in this episode:

2:17: What is utilization management?

4:00: Physicians devote approximately $26.7 billion in time spent navigating utilization management

5:02: Calculating how much time and money patients waste dealing with their insurance companies

7:14: Joe Coe recalls his first migraine attack

8:36: “Utilization management, when I hear that term, it makes my skin crawl,” says Joe

10:34- The challenges patients face in dealing with their insurance companies during their workday

11:34:- Joe’s advice for dealing with insurance companies

12:04: What is a cheat code and why is it crucial for patients to know?

15:33: What did our co-hosts Steven and Zoe learn from this episode?

Contact Our Hosts

Steven Newmark, Director of Policy at GHLF: [email protected]

Zoe Rothblatt, Patient Advocate and Community Outreach Manager at GHLF: [email protected]

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to [email protected]

Catch up on all our episodes on our website or on your favorite podcast channel.

See omnystudio.com/listener for privacy information.