Shoved to Them
Yesterday, I posted 9 things we’ve learned about Health Care this year. (It was pointed out to me that I forgot the truism that mascara makes you smarter – at least it raises the perception of your intelligence.) I felt it was fitting to write today about what I’ve learned, or relearned, about insurance companies.
1) Insurance companies are not on your side – It seems like all that money we pay every month should come with a guarantee of their looking out for our best interests, but it doesn’t. Insurance companies are not benevolent institutions. They are for-profit corporations who are answerable to shareholders. They are more interested in the bottom line than in ensuring that you have access to all of the care/equipment that you require. The process of pre-approval, denial, appeal, repeat denial, repeat appeal, reluctant approval is designed to frustrate the medical consumer into giving up or accepting less than they truly require.
As much as you have to schmooze the staff in a doctor’s office, you will have to play head games with the insurance company. Don’t back down. Don’t be intimidated. You pay the premiums and they work for you.
2)Call until you get the right listener, and then tell a good story – The health care decisions made by the insurance company shouldn’t depend on your skills as a story teller and having the right audience, but they totally do. I call until I either get an old person or a young woman and then play it up. I don’t lie or exaggerate, but I can spin a yarn when I have to. It got us past the hurdle of “Unknown diagnosis” for the nine months until a doctor finally put something down on paper. Without my ability to tug heartstrings, we wouldn’t have seen half the specialists we did, gotten as much testing as needed, or found our way through the reams of paperwork that had to be filled out.
I’m not even shy about picking my audience any longer. I’ll flat out hang up on anyone I sense isn’t a sympathetic listener. I don’t have the time to persuade them to discover their humanity. My daughter needs help, and I’m playing the cards I’ve been dealt.
3) Get help with the forms – You haven’t seen persnickety until you’ve tried to appeal an insurance denial for expensive equipment (like wheelchair wheels.) We’ve talked to families who were denied because of incorrect comma placement or typos in the equipment list. There are medical supply people who fill these things out for a living, and people in the doctors’ offices who do as well. Ask for help. Beg if you have to. If you’re fortunate, they’ll submit things for you. If not, they may be willing to proofread and check the coding.
4)Keep all the papers – We had things approved and paid only to have them denied months later and the insurance company try to force repayment. This is why you have to document everything and keep records of all communication with the insurance company. I have two binders – one for every scrap of paper (appointment notes, copies of prescriptions, phone records, receipts) from every doctor we’ve seen and attempted to see, and the other detailing every bit of contact with the insurance company ( EOB (Explanation of Benefits), approval, denial, etc). If it comes in the mail from anyone even tangentially connected with Ella’s medical care, it goes into a binder.
During our fight to have the wheels of her wheelchair covered, I recorded every phone conversation that I had with the insurance company’s representative. Once I had them over a barrel, I wasn’t about to let them slip through my fingers.
5)The In Network/Out of Network scam is totally fixable– When Ella was diagnosed with JRA 3 years ago, the in-network/out-of-network maze drained our bank accounts with blinding speed. The insurance company penalized us for using out-of-network specialists we never even saw. (Radiologists, pathologists – people who read the tests and sent reports) What we now know is to call and raise a fuss with the insurance company, loudly and often. It doesn’t take very much righteous indignation for those extra charges to magically disappear. You may have to work your way up the management chain, but they will fix this for you. You just have to be a dog with a bone – growl a little and don’t give up.
6) Don’t hesitate to call in the big guns – When we ran into walls over getting Ella’s physical therapy approved, one of the first bits of advice we heard was “Call the state Insurance Commissioner. This is their job.” While we didn’t have to, we’ve seen it slice through the red tape for the families we know. If you’ve danced to their tune, and filled out the appeal papers and they’re still saying “No,” don’t hesitate to call the state capitol and ask for help. You don’t want to be a pest to the Ins Commissioner’s office, so spread the love around. They jump just as quickly for state legislators, senators, US Representatives, US Senators, and the media.
Health care is a drum that everyone likes to beat right now. That’s to your advantage. Don’t get to the level of crying frustration before you call a politician or reporter for help.
7)Don’t be afraid to raise holy hell – Months of back and forth over whether or not a wheelchair needs wheels (yes, really) were solved with 48 hours of an all out media blitz. While the insurance companies hold a lot of cards, they are nothing in the face of a whirlwind of bad publicity. Climb to the highest mountaintop you can find and sound your barbaric yawp.
If you don’t have a mountaintop, send me an email. I’m not at all opposed to yawping for you. (shovedtothem (at) yahoo (dot) com)
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