1) Insurance companies are not on your side<\/strong> \u2013 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\u2019t. 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.<\/p>\n As much as you have to schmooze the staff in a doctor\u2019s office, you will have to play head games with the insurance company. Don\u2019t back down. Don\u2019t be intimidated. You pay the premiums and they work for you.<\/p>\n 2)Call until you get the right listener, and then tell a good story<\/strong> \u2013 The health care decisions made by the insurance company shouldn\u2019t 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\u2019t lie or exaggerate, but I can spin a yarn when I have to. It got us past the hurdle of \u201cUnknown diagnosis\u201d for the nine months until a doctor finally put something down on paper. Without my ability to tug heartstrings, we wouldn\u2019t 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.<\/p>\n I\u2019m not even shy about picking my audience any longer. I\u2019ll flat out hang up on anyone I sense isn\u2019t a sympathetic listener. I don\u2019t have the time to persuade them to discover their humanity. My daughter needs help, and I\u2019m playing the cards I\u2019ve been dealt.<\/p>\n 3) Get help with the forms \u2013 <\/strong>You haven\u2019t seen persnickety until you\u2019ve tried to appeal an insurance denial for expensive equipment (like wheelchair wheels.) We\u2019ve 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\u2019 offices who do as well. Ask for help. Beg if you have to. If you\u2019re fortunate, they\u2019ll submit things for you. If not, they may be willing to proofread and check the coding.<\/p>\n 4)Keep all the papers<\/strong> \u2013 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 \u2013 one for every scrap of paper (appointment notes, copies of prescriptions, phone records, receipts) from every doctor we\u2019ve 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\u2019s medical care, it goes into a binder.<\/p>\n During our fight to have the wheels of her wheelchair covered, I recorded every phone conversation that I had with the insurance company\u2019s representative. Once I had them over a barrel, I wasn\u2019t about to let them slip through my fingers.<\/p>\n 5)The In Network\/Out of Network scam<\/a> is totally fixable<\/strong>\u2013 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 \u2013 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\u2019t 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<\/em> fix this for you. You just have to be a dog with a bone \u2013 growl a little and don\u2019t give up.<\/p>\n 6) Don\u2019t hesitate to call in the big guns<\/strong> \u2013 When we ran into walls over getting Ella\u2019s physical therapy approved, one of the first bits of advice we heard was \u201cCall the state Insurance Commissioner. This is their job.\u201d While we didn\u2019t have to, we\u2019ve seen it slice through the red tape for the families we know. If you\u2019ve danced to their tune, and filled out the appeal papers and they\u2019re still saying \u201cNo,\u201d don\u2019t hesitate to call the state capitol and ask for help. You don\u2019t want to be a pest to the Ins Commissioner\u2019s office, so spread the love around. They jump just as quickly for state legislators, senators, US Representatives, US Senators, and the media.<\/p>\n Health care is a drum that everyone likes to beat right now. That\u2019s to your advantage. Don\u2019t get to the level of crying frustration before you call a politician or reporter for help.<\/p>\n 7)Don\u2019t be afraid to raise holy hell<\/strong> \u2013 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<\/a>. 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.<\/p>\n
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