Health Insurance Subsidies for Lupus Patients in Taiwan - Internal Medicine

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System for Health Insurance Subsidies for Lupus Erythematosus / Major Illness / Specific Illness / Special Program


Hello, Dr.
Gao.
I would like to inquire whether patients with systemic lupus erythematosus can apply for major illness or specific illness certification to receive health insurance subsidies for medications.
Alternatively, can a health insurance project be established to obtain partial subsidies for medications? I have systemic lupus erythematosus and am on continuous medication, including some out-of-pocket medications.
I previously heard from another patient who mentioned that he was able to control his condition with regular medication without any special hospitalization, organ transplantation, or biopsy diagnosis, yet he still received both major illness and project subsidies.
When I asked my doctor about the project, they indicated that a biopsy was necessary for application, but this patient claimed they had not undergone a biopsy for diagnosis.
Therefore, I would like to understand how lupus patients can obtain more health insurance medication subsidies.
Thank you!
Additionally, I have a related symptom: occasionally, the internal bending area of my middle finger experiences unexplained pain upon contact, but there are no bruises or other symptoms.
Should I be concerned that this could be related to lupus arthritis or vasculitis, or is it more likely related to muscle or fascia issues? Thank you! Ann

Ann, 30~39 year old female. Ask Date: 2022/11/25

Dr. Gao Jiankai reply Internal Medicine


Hello, thank you for your inquiry.
Here are my responses:
1.
I would like to ask if patients with systemic lupus erythematosus can apply for catastrophic illness or specific illness certification to receive medication subsidies from health insurance? Or can they apply for a health insurance project to obtain partial medication subsidies? --> If the diagnostic criteria are met, systemic lupus erythematosus can apply for catastrophic illness status, and you should discuss this with your physician.
Some medications require special applications, and certain documents, such as biopsy reports, need to be prepared.
The biopsy results must meet the health insurance reimbursement criteria for the medication to be covered; otherwise, it will indeed need to be paid out-of-pocket.
This matter should still be discussed with your physician.
2.
Occasionally, I experience unexplained pain in the internal bend of my middle finger, but there are no bruises or other symptoms.
Should I be concerned that this could be related to lupus arthritis or vasculitis, or is it more likely related to muscle or fascia issues? --> It sounds like arthritis, but a proper examination of the affected area would provide a more accurate diagnosis.
It is advisable to return for a follow-up evaluation.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital cares about your health.

Reply Date: 2022/11/25

More Info


In Taiwan, patients with systemic lupus erythematosus (SLE), commonly known as lupus, may be eligible for health insurance subsidies, including the Major Illness Card or specific illness certificates, which can help cover the costs of medications. However, the process and eligibility criteria can be complex and may vary depending on individual circumstances and the specific healthcare provider involved.

To apply for the Major Illness Card, patients typically need to provide medical documentation that confirms their diagnosis. This often includes a detailed medical history, laboratory results, and possibly a biopsy report, as lupus can manifest in various forms, including cutaneous lupus and systemic lupus. While some patients may have been granted subsidies without a biopsy, it is generally advisable to have comprehensive documentation to support the application. The requirement for a biopsy may stem from the need for definitive evidence of the disease's severity and its impact on the patient's health.

For patients who are currently using self-paid medications, it is crucial to consult with healthcare providers who are familiar with the latest regulations and practices regarding health insurance in Taiwan. They can provide guidance on the necessary steps to apply for subsidies and help navigate the complexities of the healthcare system. It is also beneficial to keep abreast of any changes in health insurance policies, as these can affect eligibility and coverage.

Regarding your additional concern about the pain in your middle finger, this symptom could potentially be related to lupus, particularly if it is accompanied by other signs such as swelling, stiffness, or redness. Lupus can lead to various musculoskeletal manifestations, including lupus arthritis, which may cause joint pain and inflammation. However, the absence of bruising and the specific nature of the pain could also suggest other conditions, such as tendonitis or a muscular issue. It is essential to discuss these symptoms with your healthcare provider, who may recommend further evaluation, including imaging studies or blood tests, to determine the underlying cause.

In summary, lupus patients in Taiwan can seek health insurance subsidies, but the process requires careful documentation and possibly a biopsy. It is advisable to work closely with healthcare providers to ensure all necessary information is submitted for the application. Additionally, any new or worsening symptoms, such as joint pain, should be evaluated by a medical professional to rule out complications related to lupus or other conditions. Regular follow-ups and open communication with your healthcare team are vital for managing lupus effectively and ensuring access to appropriate treatments.

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