Key considerations for supporting patients with insurance concerns: 1. Listen actively: Allow them to share their insurance concerns, ask open-ended questions, and repeat back what you've understood to ensure you're on the same page. 2. Show empathy and understanding: Acknowledge their frustrations, explain insurance terms simply, and validate concerns and show willingness to help. 3. Provide resources: Offer materials to help them understand their insurance option and connect patients with insurance experts to provide guidance. 4. Solve problems proactively: Identify potential issues, collaborate with healthcare teams, and advocate for patients. 5. Follow up, provide ongoing support, & celebrate successes!

Teach patients how to read and understand their Explanation of Coverage book, “medical necessity” means or how health plans have specific criteria and the expected turnaround time with decisions on authorization referals.

In the United States, insurance companies dictate the care patients can afford. My process as a nurse navigator starts with educating the patient on insurance terms, policies, and processes. Next, I find their plan and relevant policy information and explain how this affects their ability to afford the treatment we are recommending. Lastly, I empower them by helping with appeals and giving outside resources to help them overcome the challenges posed by their insurance plan.

Listen actively Ask Key questions Evaluate county free resources for support Contact the case manager of the insurance company do a peer to peer to evaluate necessity of procedure or treatment

First, assess the patient's understanding/knowledge of insurance. Then, ask patient if they have someone who can listen to our discussion about insurance. Often patients have anxiety about their health which interferes with them being able to understand what is being said. A significant other, friend or family member can talk to patient too. Patient engagement that includes a supportive person can be highly effective to help patient to understand and navigate the insurance world.

As a primary care clinician, I often see patients struggle with insurance barriers—tests not covered, medications needing approval, or limited specialist access. First, I validate their frustration and reassure them that we will find a solution together. Then, we take action: finding discounted lab rates or coupons, securing prior authorizations for imaging and medications, and personally searching for in-network specialists. If wait times are long but the need is urgent, I call offices to push for earlier appointments. Patients must know they are never alone—our role is to advocate, navigate the system, and ensure they receive the care they need.

(Disclaimer: This applies to Malaysia's healthcare system and may not be relevant elsewhere.) Helping patients navigate insurance is tough, especially here in Malaysia with our mix of public and private healthcare. Many struggle with policy jargon, language barriers, and just understanding what they're entitled to. To do better, starting by focusing on clear communication ie simplified policy summaries in multiple languages, visual aids etc is a good start. We also need to build patient confidence: workshops, support groups, and dedicated liaisons to help with claims. Finally, targeted approaches for chronic care, maternity, and emergencies are key. Empowering patients means better access to care and a more equitable system.

As medical providers, we must help patients advocate for themselves. And we must advocate for them. I recently had a patient whose neurosurgeon recommended an immediate cervical discectomy due to severe pain and nerve impingement resulting in her losing upper extremity strength very quickly. The insurance company required she complete 6 weeks of physical therapy before they’d approve the surgery. I evaluated her and documented that therapy was not appropriate and included in my documentation in detail the risks of delaying surgery. They approved her the next day! Keep fighting the good fight - even if it’s just one patient at a time!

We must listen to their concerns. Explain the basics of how the process works. Give them advice on questions when calling the insurance.